Percutaneous revascularization in a patient with anomalous origin of left main coronary artery
Rajesh Vijayvergiya1, Anil Grover, Manphool Singhal
1Rajesh Vijayvergiya, Anil Grover, Department of Cardiology, Advance Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Insights
This case report details a rare anomalous origin of the left main coronary artery (LM) from the right coronary sinus. Successful percutaneous coronary intervention (PCI) was performed, with MDCT confirming stent patency and anomaly course.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Anomalous coronary artery origin from the opposite sinus is rare.
- Percutaneous coronary intervention (PCI) for anomalous coronary arteries presents significant technical challenges.
Purpose of the Study:
- To report a rare case of anomalous left main coronary artery (LM) originating from the right coronary sinus.
- To describe the technical considerations and successful PCI in this anomaly.
- To highlight the utility of Multi-Detector Computed Tomography (MDCT) in imaging coronary anomalies.
Main Methods:
- Coronary angiography was used for diagnosis and intervention.
- Percutaneous coronary intervention (PCI) was performed using specific guide catheters.
- 64-slice Multi-Detector Computed Tomography (MDCT) was utilized for follow-up imaging.
Main Results:
- A rare case of left main coronary artery (LM) originating from the right coronary sinus with a retro-aortic course was identified.
- Successful PCI of atherosclerotic lesions in the anomalous left anterior descending (LAD) artery was achieved.
- MDCT at 4-year follow-up confirmed stent patency and delineated the anomalous LM anatomy.
Conclusions:
- Anomalous LM origin from the contralateral sinus is exceptionally rare.
- Careful selection of guide catheters is crucial for successful PCI in coronary anomalies.
- MDCT is valuable for assessing coronary anomalies and post-intervention outcomes.
Abstract:
Anomalous origin of the coronary artery from opposite coronary sinus is infrequently observed during coronary angiography. Percutaneous coronary intervention (PCI) of anomalous coronary artery is technically difficult and challenging. It requires appropriate selection of guide catheters for adequate stability, coaxial alignment and backup support during the intervention. We hereby report a rare case of anomalous origin of left main coronary artery (LM) from the right coronary sinus, having a retro-aortic course to the left side before its bifurcation into left anterior descending (LAD) and circumflex artery. The 59-year-old man had successful PCI of atherosclerotic LAD lesions. A 64-slice Multi-Detector Computed Tomography (MDCT) performed at 4 years of follow-up demonstrated patency of coronary stents and also delineated the origin and course of the anomalous LM. The case illustrates the rarity of anomalous LM, and describes technical issues during PCI and the role of MDCT in coronary anomaly imaging.
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