Endovascular therapy for congenital coronary artery anomalies in adults

Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during standard diagnostic workup for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischaemia. Interventional cardiologists may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. Complete angiographic definition is essential in order to assess functional status and plan the appropriate intervention: computed tomography and magnetic resonance imaging are useful, non-invasive tools for detecting three-dimensional morphology of the anomalies and its relationship with adjacent cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and, in particular, invasive pharmacological stress tests with or without intravascular ultrasound monitoring can correctly assess the functional significance of most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. In this brief review, the authors have focused their attention on the interventional techniques to treat various CAA subtypes, with reference to angiographic diagnosis and functional assessment.