A very rare coronary artery anomaly: Twin circumflex arteries associated with acute coronary syndrome - two cases report

Abstract

Circumflex coronary artery anomalies are the most common type so far observed. However, a dual origin of the circumflex is an extremely rare anomaly. We describe two different patients admitted to our clinic with acute coronary syndrome at the same day. Angiography revealed twin circumflex arteries: one from the left main artery and the other from the proximal right coronary artery.

Percutaneous Coronary Intervention in an Extremely Rare Case of Double Circumflex Coronary Arteries With Acute Myocardial Infarction

“…Our case is an exceptionally rare case of a PCI of anomalous RCX in the presence of double Cx arteries; to the best of our knowledge, only three such cases have been reported previously in the literature worldwide [14,16,18]. Otlu et al reported a case of twin Cx arteries originating from the left and right coronary systems in a patient with recent-onset angina and successfully performed PCI to the diseased RCX artery using the trans-radial approach [14].…”

“…Although the anomalous origin of LCX has been described to be one of the most common congenital anomalies in many large angiographic series [3][4], the occurrence of double or twin Cx coronary arteries has been reported very rarely in the literature [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In most of the reported cases of double Cx arteries, one Cx artery (LCX) had its origin from the left main artery while the other (RCX) had its origin from the right coronary sinus or the RCA [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. A similar finding was seen in our case with the LCX arising from the left main and the RCX arising from the ostio-proximal part of the RCA.…”

“…In a case reported by Sinha et al, successful primary PCI was performed to the culprit anomalous RCX in a patient with acute inferior wall MI [16]. Uğuz et al have reported a case of a middle-aged male with acute MI where twin Cx arteries were noted on CAG and successful PCI to the RCX was performed [18].…”

“…An anomalous circumflex (Cx) coronary artery arising from the right coronary sinus or the right coronary artery (RCA) is one of the most frequent coronary anomalies, seen in 34.4-57.9% of the patients with coronary anomalies [3,4]. Double Cx coronary arteries, with one originating from the left system and the other from the right system, is an exceptionally rare coronary anomaly that has been reported only a few times in the literature worldwide [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. We present a case of double Cx arteries in a middle-aged male with acute myocardial infarction (MI), and its successful management using percutaneous coronary intervention (PCI) of the diseased right Cx artery (RCX).…”

Dual circumflex coronary arteries with direct origin of accessory circumflex from the left aortic sinus

“…Moreover, twin or dual circumflex arteries have also been reported originating from both the right and the left coronary artery systems, where the accessory LCX was seen originating from the right coronary artery or the right aortic sinus. [ 1 2 ] More recently, the dual origin of the circumflex artery from the main stem of the left coronary artery has also been described. Dual circumflex coronary arteries with the accessory LCX arising from the left coronary sinus [ Figures 1 and 2 ] are rare.…”