Procedure

PCI — choosing your view

During percutaneous coronary intervention the operator picks projections that answer specific questions: how long is the lesion really? Is the ostium involved? Where exactly is the side branch take-off? Two principles drive the choice.

1. Minimise foreshortening

A vessel angled toward or away from the detector looks artificially short. The ideal working view places the lesion segment perpendicular to the X-ray beam. For the mid-LAD this is usually RAO 10 / CRA 40; for the proximal LAD, LAO 30 / CRA 30.

2. Open the bifurcation

For an LAD / diagonal bifurcation, work in the view that separates the two limbs cleanly so wires don't cross and the side branch isn't lost when the stent is deployed. The spider view does this for the left main; cranial views do it for the LAD / diagonal.

Common working pairs

• Proximal LAD: spider + LAO cranial
• Mid LAD / diagonal: RAO cranial + LAO cranial
• LCx / OM: RAO caudal + spider
• Mid RCA: LAO 45 + RAO 30
• Distal RCA / PDA: LAO cranial + PA cranial