Two Cases of Successful Primary Percutaneous Coronary Intervention in Patients With an Anomalous Right Coronary Artery Arising From the Left Coronary Cusp

Abstract

An anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital anomaly. Because of the unusual location and the noncircular luminal orifice of this anomaly, cannulation of this artery during coronary angiography and percutaneous coronary intervention (PCI) poses significant technical difficulties when using the currently available guiding catheters. Primary PCI should be performed as quickly as possible when a patient displays this condition. When we face the situation of an anomalous artery during primary PCI, it takes a much longer time to open the occluded artery. We report here on two cases of successful primary PCI with using manually manipulated catheters and Ikari type guiding catheters in 2 patients who both had an anomalous RCA arising from the left coronary cusp.

Unconventional technique to catheterize an anomalous right coronary artery system

“…There are no standardized guidelines for catheter selection for this technically challenging scenario. A method similar to ours has been reported -a hair dryer was used to heat an EBU guiding catheter to facilitate manual manipulation in that case [1]. More recently, it has been suggested that knowledge of the anatomic origin of the anomalous RCA within the aortic root may provide additional guidance [2].…”

Anomalous Right Coronary Artery From the Left Coronary Sinus With an Interarterial Course: Is It Really Dangerous?

“…Associated findings support the suggestion that the pulmonary artery has little or no effect on the constriction of coronary blood flow. Percutaneous coronary intervention (PCI)20)46)47) relieves systolic compression, but selective cannulation and stent insertion in the anomalous RCA are difficult to perform due to the small, ectopic orifice and the long, curved intramural portion of the anomalous RCA. Prior to PCI, the anomalous RCA must be evaluated by MDCT; MDCT-guided cannulation is helpful in selective cannulation and intervention 20)21).…”

“…Percutaneous coronary intervention (PCI)20)46)47) relieves systolic compression, but selective cannulation and stent insertion in the anomalous RCA are difficult to perform due to the small, ectopic orifice and the long, curved intramural portion of the anomalous RCA. Prior to PCI, the anomalous RCA must be evaluated by MDCT; MDCT-guided cannulation is helpful in selective cannulation and intervention 20)21). Coronary artery bypass grafting (CABG)32)48) is technically easy because it does not entail opening of the aorta or manipulation of the intercoronary commissure.…”

“…There have been several reports concerning these anomalies and their attendant clinical problems in Korea 20-25). The incidence of anomalous RCA is higher in angiographic studies and lower in autopsy studies compared to that of anomalous LCA, which is also a more common cause of sudden death (Table 1).…”

‘New Developed Femoral-S Carotid Catheter’ is Very Effective and Safe in Carotid Angiography: A Retrospective Study

“…The number of physicians who use this method to display vessels with origin abnormality is steadily increasing. In our laboratory, we also use catheter reshaping since long time for cases where the existing catheters are inadequate for the imaging of vessels with origin anomalies [7,8].…”