Extra-cardiac collateral to an anomalous origin right coronary artery in a post-PTCA, post-CABG patient

In the context of collateral circulation of the heart, the role of extra-cardiac collateral arteries has been thought to be negligible. We present a case in which such collateral vessel acted as a rescue, subsequent to a failed revascularisation attempt. With surgeons nowadays considering 'less is more' in terms of grafting in coronary artery bypass grafting (CABG), and more evidence arising in favour of medical therapy, we need to re-assess the role of these collateral vessels in the coronary circulation.