Coronary Stent Implantation in Patients with a Single Coronary Artery

Abstract

An isolated single coronary artery is a rare congenital anomaly and a cause of cardiac ischemia, congestive heart failure, and sudden cardiac death. Reported here are 3 cases of single coronary artery with acute myocardial infarction in which coronary stenting was performed. Also reported are the coronary blood flow patterns of the right coronary artery arising from the single left coronary artery.

Echocardiographic diagnosis of clinically silent congenital coronary artery anomalies

“…Myocardial ischemia associated with single coronary artery has also been described both in the presence [27] and absence of atherosclerosis [28]. In our series, a major branch with an intramyocardial course through the conal septum ("intraseptal" course) prior to exiting in the anterior interventricular groove was found in 5 of the 8 cases of single RCA.…”

Acute Myocardial Infarction of the Right Coronary Artery Originating From the Distal Left Circumflex Artery

“…According to 3 reports of coronary arteries that were anatomically classified as L-1 type anomaly and examined in detail by arteriography, 4-6 in 2 cases 4,5 there were atherosclerotic lesions just at the origin of the aberrant RCA, as in the present case. Although Sasao et al concluded there was no disturbance of blood flow in an aberrant RCA, based on measurement of coronary flow velocity from the LAD using a Doppler guidewire, 7 we speculate that there is a predisposition to developing coronary stenosis at the origin of an aberrant RCA from the LCX. In the present case, considering there were other atherosclerotic lesions in the LAD requiring PCI, 1 of the causes of the acute coronary syndrome was the risk factors for arteriosclerosis, but we infer that turbulent coronary flow could induce unusual stress at that anatomic site.…”

“…4 Currently PCI is performed more often than before and there are reports of PCI for patients with AMI of a single left coronary artery. 7,8 In the present case, the culprit lesion was at the origin of an aberrant RCA feeding from the distal LCX. After several defibrillations and administration of tPA, emergency coronary angiography was performed using IABP and temporary pacing because of the cardiogenic shock.…”

Congenital Heart Diseases in Aged Patients

“…CAAs are frequently managed in the elderly with angioplasty and stenting in the case of single coronary anomaly, 35 origin from the opposite sinus, 36 coronary fistulas, 37 and myocardial bridges. 38 Endovascular management of coarctation of the aorta with angioplasty and stenting has not been reported in the elderly; as a result of the fragility of the aorta and the association with aneurysmal ductus, stent-graft repair has been proposed as the primary therapeutic tool.…”