Percutaneous coronary intervention in a rare variety of single coronary artery

Abstract

We present a case of 50-year-old male having unstable angina. A rare type of single coronary artery was identified during the Coronary angiogram. The left anterior descending (LAD) and left circumflex artery (LCX) had originated from the proximal segment of right coronary artery along with significant lesion in LCX. Computed tomographic (CT) coronary angiogram confirmed the origin and course following which successful percutaneous coronary intervention (PCI) was done to LCX. The incidence of this type of coronary anomaly is 0.004%. We emphasize the importance of having a CT coronary angiogram to identify the course before the intervention. The procedural risk during PCI in patients with single coronary ostium is high. Moreover, the angulation and course of the culprit artery also pose a challenge. Good coaxial guide support by using an appropriate guiding catheter is the key to success.

Spider-Like Coronary Anatomy; the True Spider!

“…CT angiography might be very useful in detecting the anatomical malformations, acute angle take-off, the transmural course, and compression between the great arteries, which would require surgery. 4 Canbay et al 5 reported three cases of anomalous single coronary artery detected incidentally during routine coronary angiography.…”

The Role of "Catheter-Shaping" in Angiographic Success in Anomalous Coronary Events

“…3 Anomalous origin of LAD localized at the right coronary ostium, at RCA itself, and pulmonary artery have been reported. 4,5 In these cases inability to selectively cannulate coronary arteries or even mistakenly deemed to be absent, may lead to catastrophic outcomes at the time of acute myocardial infarction.…”