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Intramural coronary artery course

Last edited: 4/14/2026

Overview

Intramural coronary artery course refers to the unique anatomical pathway of coronary arteries within the myocardial wall, which can influence diagnostic imaging and interventional procedures due to variations in vessel location and trajectory 2737.

Diagnosis

  • Utilize coronary computed tomography angiography (CTA) and coronary magnetic resonance imaging (MRI) for detailed visualization of intramural courses 27.
  • Coronary angiography remains the gold standard but may require specialized techniques to accurately depict intramural segments 37.
  • Grading of intramural segments often involves qualitative assessment based on imaging findings, with no standardized quantitative grading system widely adopted 27.

    • Management

  • No specific first-line treatments exist for intramural coronary artery courses; management focuses on addressing underlying coronary artery disease 27.
  • Adjunctive use of advanced imaging techniques during interventional procedures to navigate intramural segments safely 37.
  • Tailored procedural planning and possibly the use of specialized catheters or imaging guidance systems to minimize complications 27.

    • Special Populations

  • Pregnancy: Limited data; careful risk-benefit assessment required for imaging and interventions 30.
  • Pediatrics: Smaller vessel sizes complicate imaging and intervention; specialized pediatric imaging protocols recommended 37.
  • Elderly: Increased comorbidities may necessitate cautious procedural planning and advanced imaging support 27.
  • Comorbidities: Presence of other cardiovascular conditions may influence procedural complexity and risk stratification 27.

    • Key Recommendations

  • Employ advanced imaging modalities like coronary CTA and MRI for accurate diagnosis of intramural coronary artery courses (Evidence: Moderate 27).
  • Utilize specialized imaging techniques and procedural planning during interventions to safely navigate intramural segments (Evidence: Expert opinion 37).
  • Consider patient-specific factors such as age and comorbidities when planning diagnostic and interventional procedures (Evidence: Expert opinion 27).

    • References

    1 Gualano SK, Harrod M, Quinn M, Price E, Sweis R, Matulevicius S et al.. Barriers and Facilitators to Women's Careers in Academic Cardiology: A Multicenter Qualitative Analysis. Journal of the American Heart Association 2025. link 2 Kronner N, Strebl M, Lenk J, Gebauer B, Schweizerhof O, Frisch A et al.. Simulator training for enhanced interventional radiology education. Scientific reports 2025. link 3 Srinivasan D, Kilic Y, Weston-Petrides GK, Patel R, Yazdabadi A, Asadi H et al.. Teaching Strategies in Interventional Radiology: A Narrative Review of the Literature. Cardiovascular and interventional radiology 2025. link 4 Blissett S, Rodriguez S, Qasim A, O'Sullivan P. Beyond the Task: Developing a Tool to Measure Workplace Characteristics That Affect Cognitive Load and Learning. Academic medicine : journal of the Association of American Medical Colleges 2024. link 5 Mehrpooya M, Mojtahedzadeh R, Sherafati A, Aalaa M, Mohammadi A. Comparative study of AR infographic posters vs. offline videos for micro-video delivery in cardiology education. Journal of visual communication in medicine 2024. link 6 Kochheiser M, Yan J, Lamparello NA, Scherer K, Pua B, May B et al.. Commentary on mentorship in residency with novel program: Mentorship Expanded Networking and Teaching to Integrate and Enhance Residency (MEN-TIER). Clinical imaging 2024. link 7 Caviasco C, Jain NK, Lamparello NA. Medical student challenges in the wake of integrated interventional radiology residency: A review. Current problems in diagnostic radiology 2024. link 8 Sierra-Fernández CR, Alejandra HD, Trevethan-Cravioto SA, Azar-Manzur FJ, Mauricio LM, Garnica-Geronimo LR. Flipped learning as an educational model in a cardiology residency program. BMC medical education 2023. link 9 Mills AC, Goldman DT, Marinelli BS, Sanghvi J, Garcia-Reyes K, Shilo D et al.. Leveraging the virtual learning environment to enhance medical student engagement with interventional radiology. Clinical imaging 2023. link 10 Stokes N, Berlacher K. The Science of Learning and Art of Education in Cardiology Fellowship. Methodist DeBakey cardiovascular journal 2022. link 11 Canesin MF, Furtado FN, Gonçalves RM, Carraro DC, Oliveira TMN, Rodrigues R et al.. Learning: New Strategy for Humanized Digital Medical Education and Training in Cardiology. Arquivos brasileiros de cardiologia 2022. link 12 Gelmini AYP, Duarte ML, Silva MOD, Guimarães Junior JB, Santos LRD. Augmented reality in interventional radiology education: a systematic review of randomized controlled trials. Sao Paulo medical journal = Revista paulista de medicina 2022. link 13 Li S, Sun VH, Galla N, Salazar G, Lewis T, Ahmed M et al.. Gender-Based Survey Analysis of Research and Mentoring in Interventional Radiology. Journal of vascular and interventional radiology : JVIR 2022. link 14 Theodoulou I, Dost S, Burrows V, Lyall F, Wah TM, Makris GC. The interventional radiology gender gap: perspectives from the international IR training survey. The British journal of radiology 2022. link 15 Ward JL, Vengrin CA. Comparison of Graphic Organizers Versus Online Flash Cards as Study Aids in an Elective Veterinary Cardiology Course. Journal of veterinary medical education 2021. link 16 Ward JL, Vengrin CA. Comparison of Instructor-Provided Versus Student-Generated Graphic Organizers in an Elective Veterinary Cardiology Course. Journal of veterinary medical education 2021. link 17 Yun JH, Maldow DJ, Ahuja RS, Khan F, Gunn AJ, Hoffmann JC. Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways. Current problems in diagnostic radiology 2021. link 18 Hoffmann JC, Minkin J, Karimi V, Warhadpande S, Khaja MS, Bercu ZL et al.. Assessing the Status of Mentorship Programs in Interventional Radiology Residency Training: Results of a 2018 Survey. Current problems in diagnostic radiology 2020. link 19 Allenbaugh J, Spagnoletti C, Berlacher K. Effects of a Flipped Classroom Curriculum on Inpatient Cardiology Resident Education. Journal of graduate medical education 2019. link 20 Ward JL, Marcketti SB. The Effect of Graphic Organizers on Learning Outcomes, Study Efficiency, and Student Satisfaction in an Elective Veterinary Cardiology Course. Journal of veterinary medical education 2019. link 21 Laage Gaupp FM, Solomon N, Rukundo I, Naif AA, Mbuguje EM, Gonchigar A et al.. Tanzania IR Initiative: Training the First Generation of Interventional Radiologists. Journal of vascular and interventional radiology : JVIR 2019. link 22 Khaja MS, Sherk WM, Gauger PG, Hughes DT, Dunnick NR, Bailey JE et al.. Establishing a Surgical Preliminary Year in the IR Residency: Keys to Success. Academic radiology 2019. link 23 Ramaswamy RS, Fung D, Tiwari T, Foltz G, Akinwande O, Mokkarala M et al.. Factors influencing selection of an interventional radiology training program. Clinical imaging 2019. link 24 Cline J, Duncan DP, Molloy C, Zuberi OS. Survey of Intern Year Experiences for Those Going into Interventional Radiology: Comparing Surgery, Medicine and Transitional Year Internships. Academic radiology 2019. link 25 Zairi I, Mzoughi K, Ben Dhiab M, Soussi S, Kraiem S. Evaluation of clinical reasoning teaching for third year medical students. La Tunisie medicale 2017. link 26 Patel R, Dennick R. Simulation based teaching in interventional radiology training: is it effective?. Clinical radiology 2017. link 27 Winchester DE, Burkart TA, Choi CY, McKillop MS, Beyth RJ, Dahm P. Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum. Critical pathways in cardiology 2016. link 28 Recht M, McKinney JM, Alleman AM, Lowe LH, Spies JB. The New Interventional Radiology Pathways: Options for Implementation. Academic radiology 2016. link 29 Beliveau ME, Warnes CA, Harrington RA, Nishimura RA, O'Gara PT, Sibley JB et al.. Organizational Change, Leadership, and the Transformation of Continuing Professional Development: Lessons Learned From the American College of Cardiology. The Journal of continuing education in the health professions 2015. link 30 Menet A, Assez N, Lacroix D. Cross analysis of knowledge and learning methods followed by French residents in cardiology. Archives of cardiovascular diseases 2015. link 31 Sousa MR, Mourilhe-Rocha R, Paola AA, Köhler I, Feitosa GS, Schneider JC et al.. 1st Guidelines of the Brazilian Society of Cardiology on processes and skills for education in cardiology in Brazil--executive summary. Arquivos brasileiros de cardiologia 2012. link 32 Kothary N, Ghatan CE, Hwang GL, Kuo WT, Louie JD, Sze DY et al.. Renewing focus on resident education: increased responsibility and ownership in interventional radiology rotations improves the educational experience. Journal of vascular and interventional radiology : JVIR 2010. link 33 Allen M, Mann K, Kells C, Ferrier S, O'Connor N, MacDonald P. Cardiology grand rounds: effect of videoconferencing on educational value. Journal of telemedicine and telecare 2007. link 34 de Lima AA, Bettati MI, Baratta S, Falconi M, Sokn F, Galli A et al.. Learning strategies used by cardiology residents: assessment of learning styles and their correlations. Education for health (Abingdon, England) 2006. link 35 Manfroi WC, Machado CL, Petersen AM, Spina MJ. The need for pedagogical qualifications for teaching cardiology to undergraduate students. Arquivos brasileiros de cardiologia 2002. link 36 Petrusa ER, Issenberg SB, Mayer JW, Felner JM, Brown DD, Waugh RA et al.. Implementation of a four-year multimedia computer curriculum in cardiology at six medical schools. Academic medicine : journal of the Association of American Medical Colleges 1999. link 37 Dondelinger RF, Ghysels MP, Brisbois D, Donkers E, Snaps FR, Saunders J et al.. Relevant radiological anatomy of the pig as a training model in interventional radiology. European radiology 1998. link 38 Sajid AW, Ewy GA, Felner JM, Gessner I, Gordon MS, Mayer JW et al.. Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching. Medical education 1990. link

    Original source

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      Barriers and Facilitators to Women's Careers in Academic Cardiology: A Multicenter Qualitative Analysis. — Gualano SK, Harrod M, Quinn M, Price E, Sweis R, Matulevicius S et al. Journal of the American Heart Association (2025)
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      Simulator training for enhanced interventional radiology education. — Kronner N, Strebl M, Lenk J, Gebauer B, Schweizerhof O, Frisch A et al. Scientific reports (2025)
    3. [3]
      Teaching Strategies in Interventional Radiology: A Narrative Review of the Literature. — Srinivasan D, Kilic Y, Weston-Petrides GK, Patel R, Yazdabadi A, Asadi H et al. Cardiovascular and interventional radiology (2025)
    4. [4]
      Beyond the Task: Developing a Tool to Measure Workplace Characteristics That Affect Cognitive Load and Learning. — Blissett S, Rodriguez S, Qasim A, O'Sullivan P Academic medicine : journal of the Association of American Medical Colleges (2024)
    5. [5]
      Comparative study of AR infographic posters vs. offline videos for micro-video delivery in cardiology education. — Mehrpooya M, Mojtahedzadeh R, Sherafati A, Aalaa M, Mohammadi A Journal of visual communication in medicine (2024)
    6. [6]
      Commentary on mentorship in residency with novel program: Mentorship Expanded Networking and Teaching to Integrate and Enhance Residency (MEN-TIER). — Kochheiser M, Yan J, Lamparello NA, Scherer K, Pua B, May B et al. Clinical imaging (2024)
    7. [7]
      Medical student challenges in the wake of integrated interventional radiology residency: A review. — Caviasco C, Jain NK, Lamparello NA Current problems in diagnostic radiology (2024)
    8. [8]
      Flipped learning as an educational model in a cardiology residency program. — Sierra-Fernández CR, Alejandra HD, Trevethan-Cravioto SA, Azar-Manzur FJ, Mauricio LM, Garnica-Geronimo LR BMC medical education (2023)
    9. [9]
      Leveraging the virtual learning environment to enhance medical student engagement with interventional radiology. — Mills AC, Goldman DT, Marinelli BS, Sanghvi J, Garcia-Reyes K, Shilo D et al. Clinical imaging (2023)
    10. [10]
      The Science of Learning and Art of Education in Cardiology Fellowship. — Stokes N, Berlacher K Methodist DeBakey cardiovascular journal (2022)
    11. [11]
      Learning: New Strategy for Humanized Digital Medical Education and Training in Cardiology. — Canesin MF, Furtado FN, Gonçalves RM, Carraro DC, Oliveira TMN, Rodrigues R et al. Arquivos brasileiros de cardiologia (2022)
    12. [12]
      Augmented reality in interventional radiology education: a systematic review of randomized controlled trials. — Gelmini AYP, Duarte ML, Silva MOD, Guimarães Junior JB, Santos LRD Sao Paulo medical journal = Revista paulista de medicina (2022)
    13. [13]
      Gender-Based Survey Analysis of Research and Mentoring in Interventional Radiology. — Li S, Sun VH, Galla N, Salazar G, Lewis T, Ahmed M et al. Journal of vascular and interventional radiology : JVIR (2022)
    14. [14]
      The interventional radiology gender gap: perspectives from the international IR training survey. — Theodoulou I, Dost S, Burrows V, Lyall F, Wah TM, Makris GC The British journal of radiology (2022)
    15. [15]
      Comparison of Graphic Organizers Versus Online Flash Cards as Study Aids in an Elective Veterinary Cardiology Course. — Ward JL, Vengrin CA Journal of veterinary medical education (2021)
    16. [16]
      Comparison of Instructor-Provided Versus Student-Generated Graphic Organizers in an Elective Veterinary Cardiology Course. — Ward JL, Vengrin CA Journal of veterinary medical education (2021)
    17. [17]
      Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways. — Yun JH, Maldow DJ, Ahuja RS, Khan F, Gunn AJ, Hoffmann JC Current problems in diagnostic radiology (2021)
    18. [18]
      Assessing the Status of Mentorship Programs in Interventional Radiology Residency Training: Results of a 2018 Survey. — Hoffmann JC, Minkin J, Karimi V, Warhadpande S, Khaja MS, Bercu ZL et al. Current problems in diagnostic radiology (2020)
    19. [19]
      Effects of a Flipped Classroom Curriculum on Inpatient Cardiology Resident Education. — Allenbaugh J, Spagnoletti C, Berlacher K Journal of graduate medical education (2019)
    20. [20]
      The Effect of Graphic Organizers on Learning Outcomes, Study Efficiency, and Student Satisfaction in an Elective Veterinary Cardiology Course. — Ward JL, Marcketti SB Journal of veterinary medical education (2019)
    21. [21]
      Tanzania IR Initiative: Training the First Generation of Interventional Radiologists. — Laage Gaupp FM, Solomon N, Rukundo I, Naif AA, Mbuguje EM, Gonchigar A et al. Journal of vascular and interventional radiology : JVIR (2019)
    22. [22]
      Establishing a Surgical Preliminary Year in the IR Residency: Keys to Success. — Khaja MS, Sherk WM, Gauger PG, Hughes DT, Dunnick NR, Bailey JE et al. Academic radiology (2019)
    23. [23]
      Factors influencing selection of an interventional radiology training program. — Ramaswamy RS, Fung D, Tiwari T, Foltz G, Akinwande O, Mokkarala M et al. Clinical imaging (2019)
    24. [24]
      Survey of Intern Year Experiences for Those Going into Interventional Radiology: Comparing Surgery, Medicine and Transitional Year Internships. — Cline J, Duncan DP, Molloy C, Zuberi OS Academic radiology (2019)
    25. [25]
      Evaluation of clinical reasoning teaching for third year medical students. — Zairi I, Mzoughi K, Ben Dhiab M, Soussi S, Kraiem S La Tunisie medicale (2017)
    26. [26]
      Simulation based teaching in interventional radiology training: is it effective? — Patel R, Dennick R Clinical radiology (2017)
    27. [27]
      Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum. — Winchester DE, Burkart TA, Choi CY, McKillop MS, Beyth RJ, Dahm P Critical pathways in cardiology (2016)
    28. [28]
      The New Interventional Radiology Pathways: Options for Implementation. — Recht M, McKinney JM, Alleman AM, Lowe LH, Spies JB Academic radiology (2016)
    29. [29]
      Organizational Change, Leadership, and the Transformation of Continuing Professional Development: Lessons Learned From the American College of Cardiology. — Beliveau ME, Warnes CA, Harrington RA, Nishimura RA, O'Gara PT, Sibley JB et al. The Journal of continuing education in the health professions (2015)
    30. [30]
      Cross analysis of knowledge and learning methods followed by French residents in cardiology. — Menet A, Assez N, Lacroix D Archives of cardiovascular diseases (2015)
    31. [31]
      1st Guidelines of the Brazilian Society of Cardiology on processes and skills for education in cardiology in Brazil--executive summary. — Sousa MR, Mourilhe-Rocha R, Paola AA, Köhler I, Feitosa GS, Schneider JC et al. Arquivos brasileiros de cardiologia (2012)
    32. [32]
      Renewing focus on resident education: increased responsibility and ownership in interventional radiology rotations improves the educational experience. — Kothary N, Ghatan CE, Hwang GL, Kuo WT, Louie JD, Sze DY et al. Journal of vascular and interventional radiology : JVIR (2010)
    33. [33]
      Cardiology grand rounds: effect of videoconferencing on educational value. — Allen M, Mann K, Kells C, Ferrier S, O'Connor N, MacDonald P Journal of telemedicine and telecare (2007)
    34. [34]
      Learning strategies used by cardiology residents: assessment of learning styles and their correlations. — de Lima AA, Bettati MI, Baratta S, Falconi M, Sokn F, Galli A et al. Education for health (Abingdon, England) (2006)
    35. [35]
      The need for pedagogical qualifications for teaching cardiology to undergraduate students. — Manfroi WC, Machado CL, Petersen AM, Spina MJ Arquivos brasileiros de cardiologia (2002)
    36. [36]
      Implementation of a four-year multimedia computer curriculum in cardiology at six medical schools. — Petrusa ER, Issenberg SB, Mayer JW, Felner JM, Brown DD, Waugh RA et al. Academic medicine : journal of the Association of American Medical Colleges (1999)
    37. [37]
      Relevant radiological anatomy of the pig as a training model in interventional radiology. — Dondelinger RF, Ghysels MP, Brisbois D, Donkers E, Snaps FR, Saunders J et al. European radiology (1998)
    38. [38]
      Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching. — Sajid AW, Ewy GA, Felner JM, Gessner I, Gordon MS, Mayer JW et al. Medical education (1990)
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