Anomalous coronary origin and severe calcification: a challenge for percutaneous coronary intervention. Case report

We present the case of a 68-year-old man with stable angina and complex multivessel coronary artery disease. Computed tomography revealed a critically calcified stenosis of the left anterior descending artery and an anomalous origin of the right coronary artery from the left coronary sinus, with an interarterial course and severe calcification. Following initial revascularisation of the left anterior descending artery using rotational atherectomy, the right coronary artery was treated in a staged procedure. Because the severe stenosis and challenging ostial anatomy precluded advancement of an intracoronary imaging catheter, angiography-guided intravascular lithotripsy was performed. This approach enabled effective plaque modification and the successful implantation of two drug-eluting stents, with an optimal angiographic result. This case highlights the safety and effectiveness of intravascular lithotripsy as an alternative treatment for anomalous coronary anatomy and severely calcified lesions when intracoronary imaging guidance is not feasible.