Case report: Treatment of a patient with STEMI and cardiogenic shock caused by RCA originating from LAD

Abstract

The right coronary artery (RCA) originating from the left anterior descending artery (LAD) is a very rare variation of coronary artery anomaly. This kind of anomaly is usually considered to be clinically benign. Here, we present an acute myocardial infarction patient with a single coronary artery (SCA), in whom the LAD and RCA are both occlusive at the same time. He suffered from ventricular fibrillation, cardiogenic shock, and severe bradyarrhythmias many times. Fortunately, this patient survived from death through our effective medical procedures.

Keywords: AMI; anomaly; drug-coated balloon (DCB); percutaneous coronary intervention (PCI); ventricular fibrillation (VF).

FIGURE 1

A 18-lead electrocardiogram of the patient showing ST elevation in V2–V4 leads with widespread inverted T-waves in inferior, posterior, and right ventricular leads.

FIGURE 2

Emergency coronary angiography at the onset of acute myocardial infarction. The results showed that the proximal left anterior descending artery (LAD) was completely occluded (A). Balloon dilatation was performed on the occlusive site (B). TIMI grade 3 flow was restored in LAD and right coronary artery (RCA) (C). The second coronary angiography at 4 months after myocardial infarction. The results showed high-grade lesion at the proximal LAD, as well as at LAD/RCA bifurcation and LAD/diagonal bifurcation (D). Drug-eluting balloons were used to dilate the diagonal branch (E) and the RCA (F). A drug-eluting stent in LAD and 2 balloons in D1 and RCA were dilated simultaneously for kissing balloon inflation (G). Final imaging results after procedure (H).

FIGURE 3

Coronary computed tomography angiography (CTA) was re-examined one month after PCI and resulting images (A–D) confirmed the anomalous origin of the right coronary artery.