Percutaneous coronary intervention in a rare variety of single coronary artery

Area of Science:

• Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Unstable angina necessitates thorough etiological investigation.
• Coronary artery anomalies are rare but can significantly impact cardiac interventions.
• Accurate anatomical delineation is crucial for procedural success and patient safety.

Observation:

• A 50-year-old male presented with unstable angina.
• Coronary angiography revealed a rare single coronary artery anomaly: the left anterior descending (LAD) and left circumflex (LCX) arteries originated from the proximal right coronary artery (RCA).
• A significant lesion was identified in the LCX.

Findings:

• Computed tomographic (CT) coronary angiography precisely confirmed the anomalous origin and course of the coronary arteries.
• Successful percutaneous coronary intervention (PCI) was performed on the stenotic LCX.
• The incidence of this specific coronary anomaly is exceptionally low, estimated at 0.004%.

Implications:

• CT coronary angiography is vital for pre-procedural anatomical assessment in cases of coronary anomalies.
• Patients with single coronary ostium anomalies face heightened procedural risks during PCI due to complex vessel anatomy.
• Optimal guide catheter selection and coaxial support are critical for managing challenging coronary anatomy during PCI.