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Case Reports
. 2022 Nov 11;18(1):317-321.
doi: 10.1016/j.radcr.2022.10.026. eCollection 2023 Jan.

Primary percutaneous coronary intervention on split left coronary artery: Two case reports

Xhevdet Krasniqi  1   2 , Aurora Bakalli  1   2 , Hajdin Çitaku  2 , Dardan Koçinaj  3
Affiliations
Case Reports

Primary percutaneous coronary intervention on split left coronary artery: Two case reports

Xhevdet Krasniqi et al. Radiol Case Rep. .

Abstract

The split left coronary artery (LCA) is an anomaly of coronary arteries connection related to the aorta, presenting more often in patients who underwent invasive coronary angiography compared to coronary computed tomography angiography. Although this anomaly causes no hemodynamic impairment, failure to recognize may lead to incorrect diagnosis and prolonged procedures during acute myocardial infarction resulting in serious complications. We report 2 cases of split left coronary artery presenting with acute myocardial infarction who underwent primary percutaneous coronary interventions (pPCI) with excellent outcomes. In the both cases, electrocardiogram demonstrated ST-segment elevation and cardiac biomarkers were increased. Also, before coronary angiography in both patients echocardiographic examination was performed revealing hypokinesis who corresponded with the territory of occluded coronary arteries. During invasive further coronary examinations split left artery was found, besides the culprit lesion in the left anterior descending artery (LAD). Successful percutaneous stenting was performed on LAD achieving TIMI flow grade 3 in both cases. Prompt recognition of split LCA in the setting of acute myocardial infarction during pPCI, it is essential to achieve appropriate treatment and avoid potential clinical consequences.

Keywords: Artery anomalies; Split coronary artery.

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Figures

Fig 1
Fig. 1
Coronary angiography showing split left coronary arteries (case no.1). (A) Separately engaged LCx (arrow). (B) Separately engaged LAD (arrow). (C) Separate ostia for LAD and LCx (arrows). (D) Culprit lesion in mid-LAD (arrows).
Fig 2
Fig. 2
Primary percutaneous coronary intervention in LAD (case no.1). (A) Stent deployment. (B) The final angiographic result.
Fig 3
Fig. 3
Coronary angiography showing absence of left main coronary artery (case no. 2). (A and B) LAD and LCx arising from separate ostia in the left coronary sinus (arrows). (C) Separately engaged LAD detecting culprit lesion (arrow). (D) Separately engaged LCx (arrow).
Fig 4
Fig. 4
Primary percutaneous coronary intervention in LAD (case no 2). (A) The stent balloon is inflated, deploying the stent. (B) The final angiographic result.
See this image and copyright information in PMC

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