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Anomalous circumflex artery: intravascular ultrasound imaging of dynamic compression and "two wire-two vessel"

Ryan G Schrale, K M Channon, O J Ormerod

    International Journal of Cardiology
    |November 4, 2006
    PubMed

    Insights

    Anomalous origin of the left circumflex artery, a common congenital heart variation, can lead to accelerated atherosclerosis. This case highlights a successful intervention for myocardial infarction in such a patient.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Congenital Heart Disease

    Background:

    • Anomalous origin of the left circumflex artery (ALCX) is the most common coronary anomaly.
    • ALCX is associated with an increased risk of focal accelerated atherosclerotic disease.
    • Non-ST elevation myocardial infarction (NSTEMI) can occur in patients with ALCX.

    Observation:

    • A 54-year-old man presented with NSTEMI.
    • He had a retroaortic ALCX with a proximal culprit lesion.
    • Intravascular ultrasound revealed dynamic lumen compression.

    Findings:

    • The patient experienced NSTEMI due to a lesion in his anomalous circumflex artery.
    • Percutaneous coronary intervention (PCI) was performed.
    • A "two wires-two vessel" technique provided enhanced support during PCI.

    Implications:

    • This case demonstrates a successful PCI strategy for complex ALCX anatomy.
    • "Two wires-two vessel" technique is recommended for anomalous circumflex interventions.
    • Understanding ALCX pathophysiology is crucial for managing atherosclerotic complications.

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