Evaluation of High-Risk Anatomical Features in Single and Opposite-Sinus Origin Coronary Artery Anomalies Using Coronary Computed Tomography Angiography

Objective: To characterize the anatomical spectrum of a single coronary artery (SCA) and an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) and to assess high-risk features using Coronary computed tomography angiography (CCTA)-based quantitative parameters. Methods: A retrospective review of 2513 consecutive CCTA examinations performed between June 2021 and December 2025 was conducted. Patients diagnosed with ACAOS or SCA were included. Coronary origin, course patterns, and morphological characteristics were analyzed. High-risk features—including interarterial course, intramural segment, acute take-off angle, slit-like ostium, intramural length, and interluminal space (ILS)—were quantitatively assessed using multiplanar and curved MPRs. Results: Twenty-two patients (0.88%) were identified (ACAOS: 0.64%, n = 16; SCA: 0.24%, n = 6). All SCA cases showed benign courses. Among ACAOS patients, 62.5% had an interarterial course. In this subgroup, the mean take-off angle was 14.4° ± 4.5°, with universal slit-like ostium and intramural course. Mean intramural length was 9.21 ± 2.00 mm and minimal ILS was 0.87 ± 0.12 mm. Conclusions: CCTA enables comprehensive anatomical characterization of morphological features associated with higher risk in patients with ACAOS and SCA. Quantitative assessment of parameters such as the take-off angle, intramural course, slit-like ostium, intramural length, and interluminal space may complement clinical evaluation, although further prospective studies incorporating functional ischemia assessment and clinical outcome data are needed to clarify their clinical significance.