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. 2013 Apr 19;8(1):e46-e48.
doi: 10.1016/j.jccase.2013.03.012. eCollection 2013 Jul.

A patient with anomalous right coronary artery originating from the left anterior descending artery who underwent complex percutaneous coronary intervention: A case report

Zafer Elbasan  1 , Durmuş Yıldıray Şahin  1 , Mustafa Gür  1 , Murat Çaylı  1
Affiliations

A patient with anomalous right coronary artery originating from the left anterior descending artery who underwent complex percutaneous coronary intervention: A case report

Zafer Elbasan et al. J Cardiol Cases. .

Abstract

An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. A 71-year-old patient presented with severe exertional angina for 10 days. Coronary angiography revealed that an anomalous RCA originated from the proximal LAD. The anomalous RCA had also critical ostial stenosis and the LAD had a critical lesion before origin of RCA (95%) and chronic total occlusion (CTO) at DII branch level. Furthermore, extremely tortuous circumflex (Cx) artery had critical tandem lesions at the mid portion. Surgical treatment was offered, but the patient refused the surgery. We decided to perform percutaneous coronary intervention (PCI). The first stage of PCI was on Cx artery. Two floppy guide wires were placed into the Cx artery and a long drug-eluting stent (DES) could be placed. Secondly, the LAD CTO lesion could be crossed by Confianza pro 9 wire. After the predilatation, another DES was placed into the LAD CTO region. Then all other significant lesions were successfully treated with PCI in a single session. <Learning objective: An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. This is the first report of case of a patient with an anomalous RCA originating from the proximal LAD and complex coronary atherosclerosis, who underwent successful complex percutaneous coronary intervention (PCI) in a single session. PCI may be an alternative treatment choice to surgery, especially in patients with high surgical risk and complex coronary anatomy.>.

Keywords: Angina; Anomaly; Coronary; Intervention.

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Figures

Fig. 1
Fig. 1
Anteroposterior cranial view of coronary angiography demonstrates right coronary artery originating from left anterior descending coronary artery (LAD) (dark arrow shows the LAD chronic total occlusion lesion, white arrow shows atherosclerotic lesion in the proximal LAD just before the ostium of anomalous right coronary artery).
Fig. 2
Fig. 2
Lateral view of coronary angiography demonstrates right coronary artery originating from left anterior descending coronary artery and atherosclerotic lesions in the ostium of right coronary artery and mid portion of circumflex artery (white arrows show severe tandem atherosclerotic lesions in the mid portion of circumflex artery, dark arrow shows atherosclerotic lesion in the ostium of anomalous right coronary artery).
Fig. 3
Fig. 3
Lateral view of coronary angiography showed the critical lesion at the ostium of anomalous right coronary artery.
See this image and copyright information in PMC

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