Rare Case of STEMI Involving an Anomalous Single Coronary Artery Arising From the Ascending Aorta

ST-segment elevation myocardial infarction in an anomalous single coronary artery with high take-off is a rare occurrence with very few cases reported to date.

A 42-year-old man with testicular seminoma undergoing chemotherapy presented with an inferior ST-segment elevation myocardial infarction. Coronary angiography revealed a thrombotic lesion of the anomalous single coronary artery. The patient underwent percutaneous intervention with thrombus aspiration, was managed with dual-antiplatelet therapy and anticoagulation, and was followed up in an outpatient setting with a computed tomography angiogram.

Stenting was deferred, considering the patient's complex coronary anatomy and overall clinical condition. The possible mechanism of the event may be multifactorial but is likely to be precipitated by the recent chemotherapy-associated vascular toxicity.

This case highlights the diagnostic and therapeutic challenges of such unusual clinical presentations, highlighting the importance of multimodality evaluation and treatment, which should be individualized to each patient scenario.