Superdominant Circumflex Thrombosis With Occluded LAD and Absent RCA Ostium

Area of Science:

• Cardiology
• Anatomical Variations
• Interventional Cardiology

Background:

• Single coronary artery anomalies are rare, with absent right coronary artery ostium being exceptionally uncommon.
• A superdominant left circumflex artery (LCx) is a variation where the LCx supplies a territory typically perfused by the right coronary artery (RCA).

Observation:

• An 80-year-old male patient presented with a rare coronary anomaly: a superdominant left circumflex artery providing complete myocardial supply to the territory usually perfused by the right coronary artery.
• Coronary angiographic images confirmed the absence of the right coronary artery ostium and the anomalous supply pattern.

Findings:

• This case represents the first documented instance of primary percutaneous coronary intervention (PCI) performed in a patient with this specific superdominant left circumflex artery anatomy.
• The successful PCI addressed the coronary event while managing the unique anatomical challenge.

Implications:

• This case underscores the importance of recognizing rare coronary anomalies during diagnostic procedures.
• Managing coronary events in patients with single coronary arteries requires careful consideration due to the extensive myocardial territory at risk.
• Primary PCI in such complex anatomies demonstrates the feasibility and potential of interventional cardiology to manage these rare conditions.