Percutaneous coronary intervention in patients with anomalous origin of coronary artery presenting with acute coronary syndrome: A case series

Abstract

Coronary artery anomalies are found in 0.6%-1.5% of patients undergoing diagnostic coronary angiogram. Intervention in these patients poses a particular technical challenge secondary to the aberrancies in the vessel origin and course. From March 2011 to February 2013, 13 cases with complex coronary artery anomalies were observed among 2482 patients undergoing CAG (0.52%) at our cath lab. Only three patients had severe stenosis in the anomalous artery sufficient to require an intervention and had presented with myocardial infarction. PCI was performed successfully in these 3 patients two of which had anomalous left circumflex artery and the other having an anomalous right coronary artery.

Steam-deformed Judkins-left guiding catheter with use of the GuideLiner® catheter to deliver stents for anomalous right coronary artery

“…Performing PCI in these patients is challenging due to the difficulty of coaxially guiding catheters. 3 In this case, we were unable to engage either of two commonly used catheters; therefore, we used hot steam to deform a Judkins-left guiding catheter and successfully engage coaxially. Previous report showed the benefit of right radial approach for an anomalous origin of the RCA; 5 however, our case could not tolerate trans-radial approach because of the diameter of the radial artery.…”

“…Adequate guiding support during PCI for an anomalous origin is crucial for successful stent insertions. Previous case reports suggested that the Amplatz-left catheter is an option for PCI, 3 whereas other reports supported the use of the Judkins-left catheter. 4 We have found it difficult in most cases; however, to engage the guiding catheter and have needed to deform the catheters to accommodate the patients’ coronary origins.…”

Cases of Single Coronary Artery

“…Thus, no standard treatment for single coronary artery has been evidently available yet and management purely depends on the individual patient condition. 10,11 In the second case, the patient underwent percutaneous coronary intervention with implantation of stent in the distal anomalous right coronary artery without any consequences. As the patient has left main coronary artery dominant system, thus she should be maintained on regular follow-up to avoid future complications.…”

ST-segment elevation myocardial infarction in a patient with anomalous origin of left circumflex coronary artery

“…Also, in a case series of anomalous LCX PCI, Morgan et al mentioned that the incidence of acute presentations was higher in the anomalous LCX group, compared with the non-anomalous LCX group, suggesting that plaque rupture was more common in anomalous LCX due to their tortuous course and the shear stress alteration within the vessel. Furthermore, Blanchard et al and Karur et al demonstrated that the retroaortic type of LCX is selectively predisposed to atherosclerotic disease [6,7]. The explanation Emergency diagnostic coronary angiography.…”