Anatomical Variations of Coronary Arteries: Clinical Implications, Imaging Advances, and Management Strategies

Anatomical variations of the coronary arteries, though often under-recognized, hold critical implications for the diagnosis, management, and prognosis of cardiovascular conditions.This narrative review explores the spectrum of coronary artery anomalies (CAAs), their prevalence, and clinical significance, with a particular emphasis on their role in sudden cardiac events, ischemic heart disease, and procedural complications.Advances in non-invasive imaging modalities-such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and intravascular ultrasound (IVUS)-have enabled detailed visualization of coronary anatomy, enhancing diagnostic accuracy and preoperative planning.Through illustrative case studies and evidence-based analysis, this review outlines the impact of coronary anatomical variants on interventional procedures like percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).It further highlights emerging technologies, including artificial intelligence, 3D modeling, and genomic insights, which are shaping future strategies in coronary diagnostics and therapeutics.A multidisciplinary, patient-centered approach remains pivotal in optimizing outcomes.The article concludes by identifying key research priorities to advance understanding and clinical management of CAAs.