Nonatherosclerotic coronary artery disease: more than just stenosis.

Coronary angiography is most commonly performed to evaluate atherosclerotic coronary artery stenosis. However, it is important to be aware of the spectrum of coronary anomalies, including congenital and acquired nonatherosclerotic conditions. Potentially fatal congenital coronary anomalies may manifest at any age. If not recognized, such anomalies may prevent complete assessment of coronary anatomy in patients evaluated for atherosclerotic disease. Detection of coronary anomalies associated with congenital conditions, such as transposition of the great arteries, a single ventricle, or tetralogy of Fallot, is important prior to surgery to prevent complications and allow appropriate bypass during surgery. Acquired nonatherosclerotic coronary disease may occur as a primary abnormality or as part of a multisystem disorder and may mimic atherosclerotic disease. Although most nonstenosing coronary anomalies are uncommon or rare, they are individually important and many are treatable. Knowledge of variant coronary anatomy and the appearances of nonatherosclerotic coronary anomalies is essential for good patient care.