Bifurcation Intervention in Single Coronary Artery

Area of Science:

• Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Congenital coronary artery anomalies are rare but can lead to significant cardiovascular events.
• A single coronary artery arising from the right sinus of Valsalva is an uncommon anomaly.
• Anomalous coronary arteries, particularly the left circumflex artery, can be challenging to treat due to their course.

Observation:

• A 77-year-old male presented with angina on effort.
• Coronary angiography and CT revealed a single coronary artery originating from the right sinus of Valsalva.
• Severe stenosis was identified in the bifurcation of the obtuse marginal branch of an anomalously originating left circumflex artery.

Findings:

• Percutaneous coronary intervention (PCI) was performed for the complex bifurcation lesion.
• Intravascular ultrasound (IVUS) guidance was utilized for precise stent placement.
• An everolimus-eluting stent was successfully implanted in the left circumflex artery bifurcation.
• Kissing balloon inflation was performed using specialized microcatheter systems for optimal lesion coverage.

Implications:

• This case demonstrates the feasibility of complex PCI in a single coronary artery anomaly.
• Intravascular ultrasound and guide extension catheters are valuable tools for managing challenging coronary bifurcations.
• Successful intervention can alleviate symptoms and improve outcomes in patients with coronary anomalies.