A case of stent thrombosis presenting as acute myocardial infarction related to right coronary artery originating from the left coronary system

Abstract

Right coronary artery (RCA) originating from the left coronary system is a subtype of single coronary artery (SCA) anomaly, and the origin of RCA as a branch from the left anterior descending artery (LAD) is a very rare variant. A 55-year-old male who had a percutaneous coronary intervention (PCI) history was hospitalized due to acute coronary syndrome. Coronary angiography revealed an aberrant RCA originating from the mid-LAD as well as stent thrombosis. A successful PCI was performed and he was discharged from the hospital three days after the PCI. It is known that there is an increased incidence of atherosclerosis and stent thrombosis in coronary anomaly patients. Therefore, interventional cardiologists should consider the most suitable PCI strategy before stenting and avoid complex techniques.

Keywords: Coronary vessel anomalies; percutaneous coronary intervention; single coronary artery anomaly; stent thrombosis.

Figure 1.

Electrocardiography demonstrates ST-segment elevation.

Figure 2.

(A) Coronary angiography illustrating the complex coronary intervention on LAD-RCA bifurcation; (B) Appearance of stent thrombosis in RCA stent in caudal position; (C,D) Predilatations before stenting with semi-compliant balloons; (E) Appearance of stent implantation; (F,G) LAD postdilatation with balloon because of a hazy image.