Percutaneous coronary intervention in a rare case of Type V dual LAD

Congenital coronary anomalies are rare and reported to occur in 0.64-1.3% of patients undergoing coronary angiography. The dual left anterior descending coronary artery (LAD) is a rare coronary anomaly defined as the presence of two LADs in the anterior interventricular sulcus (AIVS). It consists of a short LAD that ends high in the AIVS and a longer LAD that enters the distal AIVS and feeds apex. Percutaneous interventions are even more uncommon in dual LAD especially Type V LAD. Thus we describe an interesting case of percutaneous transluminal coronary angioplasty (PTCA) with stenting to Type V dual LAD in a patient with chronic stable angina who was refractory to maximal anti-anginal medications. Our case was unique for these aspects - 1)Type V dual LAD is rare.2)Ramus artery is present in fewer cases of dual LAD.3)Long LAD had a myocardial bridge.4)Few cases have been reported of PTCA with stenting to short LAD. <Learning objective: The excerpts which can be taken from this interesting case report are - (1) Always look for the artery supplying the apical area of the heart. (2) If the apical area appears bare on left heart catheterization, then consider a Type I left anterior descending coronary artery (LAD), especially if the RCA territory supplies the apical area or consider a remote possibility of a dual LAD with separate origin of its distal LAD. (3) If in a stress test, the ischemia is localized to the apex then the physicians can consider the anomalous distal LAD to be the culprit vessel in these rare cases. (4) Revascularization of short proximal LAD will benefit the patient in reducing symptomatology if diseased. (5) PTCA with stenting can also be an effective alternative to coronary artery bypass grafting (CABG) in patients with dual LAD.>.