Citation, DOI and article data
The conus artery is a small early branch off the right coronary artery (RCA) circulation.
The artery has a variable distribution, but usually supplies a region of the anterior interventricular septum and the conus of the main pulmonary artery (hence its name).
The artery may arise directly off the right coronary cusp, and this variant appears to have a significant genetic component. The variant is present in ~50% of Americans, but 38% of Britons, 27% of Pakistanis, and only 10% of the Japanese population.
Since it supplies the interventricular septum, it may be enlarged in hypertrophic cardiomyopathy 4.
Vieussens' arterial ring is an anastomotic conduit between the conus artery and the left coronary circulation 6.
Although an acute occlusion of the tiny artery has been shown to result in S-T elevation, another more important role it serves in pathophysiology is that of a route of collateral circulation. The conus artery has been shown to collateralise with the more distal acute marginal branch in RCA stenosis/obstruction, and collateralise with the left anterior descending artery (LAD) in LAD stenosis/obstruction, providing a potentially vital collateral pathway.
- 1. Kini S, Bis KG, Weaver L. Normal and variant coronary arterial and venous anatomy on high-resolution CT angiography. AJR Am J Roentgenol. 2007;188 (6): 1665-74. doi:10.2214/AJR.06.1295 - Pubmed citation
- 2. Matthews RV, Oesterle SN. Precordial ST elevation with acute conus branch occlusion. Cathet Cardiovasc Diagn. 1989;17 (3): 180-2. Pubmed citation
- 3. Levin DC. Pathways and functional significance of the coronary collateral circulation. Circulation. 1975;50 (4): 831-7. Pubmed citation
- 4. Sumimoto T, Hamada M, Ohtani T et-al. A large conus artery in patients with hypertrophic cardiomyopathy. Heart Vessels. 1992;7 (1): 52-5. Pubmed citation
- 5. Villa AD, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary artery anomalies overview: The normal and the abnormal. World journal of radiology. 8 (6): 537-55. doi:10.4329/wjr.v8.i6.537 - Pubmed
- 6. Doğan N, Dursun A, Özkan H. Vieussens' arterial ring: a rare coronary variant anatomy. Diagn Interv Radiol. 2019;25(2):109-113. doi:10.5152/dir.2019.17449