Utility of coronary computed tomography guidance for intervention of an anomalous right coronary artery

A case of a patient with an anomalous right coronary artery arising anteriorly and superiorly to the left main coronary artery from the left coronary cusp presented a dilemma in terms of treatment strategy for the ostial slit-like lesion and the atherosclerotic lesion in the mid vessel. Both lesions appeared severe on angiography, but the vessel could not be easily cannulated with diagnostic catheters for ideal visualization. Computed tomographic angiography (CTA) allowed high-resolution imaging of the artery, its location and course, and allowed characterization of the ostial lesion as a non-atherosclerotic, but significant, stenosis and showed the mid lesion to be a severe typical atherosclerotic plaque. In addition, CTA served as a map for the selection of optimal views of the coronary artery for cannulation and suggested the use of the guide catheter that was ultimately successful in addressing the unusual location of this ostium and in supporting the implantation of drug-eluting stents safely in the ostial and mid-vessel stenoses. Although previous reports are published on interventional treatment of slit-like ostia of anomalous coronary arteries, this is the first report to our knowledge of the concomitant use of CTA to support interventional treatment of a slit-like ostium.