Primary percutaneous coronary intervention in the left main stem of a monocoronary artery

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Anatomical variations in coronary arteries can predispose individuals to cardiovascular events.
• Monocoronary artery, a rare congenital anomaly, presents unique challenges in diagnosis and treatment.
• Myocardial infarction in the context of anomalous coronary arteries requires careful consideration of treatment strategies.

Purpose of the Study:

• To describe a case of anterior wall myocardial infarction secondary to a rare monocoronary artery anomaly.
• To illustrate the successful interventional management of acute coronary occlusion in a patient with a monocoronary artery.
• To highlight the importance of comprehensive coronary angiography in identifying and treating complex coronary artery variations.

Main Methods:

• Coronary angiography was performed in a 71-year-old female presenting with evolving anterior wall myocardial infarction.
• The patient was treated with intracoronary abciximab, stenting of the left main stem/left anterior descending artery transition, and kissing balloon inflation.
• Angiographic assessment of the coronary anatomy and the intervention's success was performed.

Main Results:

• Coronary angiography revealed a rare monocoronary artery originating from the right sinus of Valsalva.
• A thrombotic lesion occluded the left anterior descending and circumflex coronary arteries.
• The interventional procedure resulted in an excellent angiographic outcome with restored coronary blood flow.

Conclusions:

• Monocoronary artery anomalies can lead to acute coronary syndromes, including myocardial infarction.
• Percutaneous coronary intervention, including stenting and balloon angioplasty, can be effective in managing acute occlusions in anomalous coronary arteries.
• This case underscores the successful management of a complex coronary anomaly presenting as myocardial infarction.