Percutaneous Coronary Intervention in Anomalously arising Coronary Arteries
Satyavan Sharma1, Govind M Pillai2, Anil Potdar3
1Honorary Consultant, Department of Cardiology, Bombay Hospital & Medical Research Centre.
Insights
Anomalous origin of coronary arteries (ACA) presents unique challenges in diagnosis and treatment. Percutaneous coronary intervention (PCI) for ACA can achieve excellent outcomes with careful technique.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Anomalous origin of coronary arteries (ACA) is a rare congenital condition.
- ACA can lead to significant clinical complications if not properly managed.
- Angiographic recognition and percutaneous intervention for ACA are complex.
Purpose of the Study:
- To highlight the difficulties in diagnosing ACA via angiography.
- To describe the challenges encountered during percutaneous coronary intervention (PCI) for ACA.
- To report the outcomes of PCI in patients with ACA.
Main Methods:
- Retrospective analysis of 27 patients undergoing PCI for ACA between 2010 and 2019.
- Data collected from interventional cardiologists in tertiary care centers.
- Categorization of ACA into four groups based on origin.
Main Results:
- Four types of ACA were identified: L-ACAOS (n=5), R-ACAOS (n=4), LCx from RS (n=12), and RCA from PS (n=6).
- Successful PCI required careful guiding catheter selection and various accessories.
- Radial access showed potential benefits for R-ACAOS, though femoral access was more common.
Conclusions:
- Percutaneous management of ACA is feasible despite its complexity.
- Careful procedural planning and execution are crucial for successful outcomes.
- PCI offers an effective treatment option for selected patients with ACA.
Objective:
Anomalous origin of coronary arteries (ACA) is rare. The objective of this communication is to describe the difficulties in angiographic recognition and challenges in percutaneous management.
Methods:
The material for this retrospective study was provided by contributing interventional cardiologists practicing in tertiary care centers.
Results:
From 2010 to 2019, 27 patients underwent percutaneous coronary intervention (PCI) for ACA. Four groups were encountered including anomalous origin from opposite sinus [left anomalous coronary artery from opposite sinus (L-ACAOS, n = 5), right anomalous coronary artery from opposite sinus (R-ACAOS n = 4)], origin of left circumflex from right sinus (n = 12), and origin of right coronary artery from posterior sinus (n = 6). The selection of a guiding catheter is the crucial step and a wide range of accessories was required to achieve an excellent outcome. Radial access may have an advantage in R-ACAOS, although the majority had a successful procedure from the femoral approach.
Conclusion:
Percutaneous management of patients with anomalous coronary arteries is challenging but can be accomplished with an excellent immediate outcome.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
12:00Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction