Navigating the Uncommon: PCI to an Anomalous Right Coronary Artery With a Malignant Course Following Failed Arterial
Ayman Helal1, Mohsin Farooq1, Mohamed Alama2
1Department of Cardiology, Kettering General Hospital, University Hospitals of Northamptonshire (UHN), Kettering, UK.
Insights
This case report details the successful percutaneous coronary intervention (PCI) for a complex anomalous right coronary artery (RCA) in a patient with prior failed bypass surgery. It highlights challenges in treating rare coronary anomalies and severe in-stent restenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- A 67-year-old male with a history of failed coronary artery bypass grafting (CABG) presented with non-ST elevation myocardial infarction (NSTEMI).
- The patient had severe in-stent restenosis (ISR) in the left anterior descending (LAD) artery and degenerated grafts.
- An underlying anomalous origin of the right coronary artery (RCA) with a malignant course was identified.
Observation:
- The anomalous RCA presented significant engagement challenges during percutaneous coronary intervention (PCI) due to its unusual anatomical course between the aorta and pulmonary artery.
- CT coronary angiography was crucial for accurately delineating the complex anatomy and planning the intervention.
Findings:
- Successful PCI was achieved for the anomalous RCA despite the anatomical complexities.
- The case demonstrates the feasibility of interventional treatment for rare coronary artery anomalies in high-risk patients.
Implications:
- This case underscores the importance of advanced imaging techniques like CT coronary angiography in diagnosing and managing complex coronary artery anomalies.
- It highlights the technical difficulties and successful strategies for performing PCI in challenging anatomies, offering insights for interventional cardiologists.
- The report contributes to the understanding of managing patients with prior failed revascularization and complex coronary artery disease.
Abstract:
A 67-year-old male presented with non-ST elevation myocardial infarction (NSTEMI) with underlying anomalous origin of the right coronary artery (RCA) and a malignant course between the aorta and pulmonary artery. Previous CABG with LIMA and RIMA grafts had failed, leaving the patient with severe in-stent restenosis (ISR) in the LAD and degenerated, blocked grafts. The patient underwent percutaneous coronary intervention (PCI) to the anomalous RCA, which posed challenges in engagement due to its anomalous course. This case report discusses the complexities of managing such anatomies, emphasizing the role of CT coronary angiography, the difficulty of engaging anomalous arteries, and the techniques used to achieve successful PCI.
