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Case Reports
. 2024 Jun 1;16(6):e61505.
doi: 10.7759/cureus.61505. eCollection 2024 Jun.

Successful Management of Anomalous Lipton R-III Right Coronary Artery Chronic Total Occlusion

Ankit Gupta  1 , Sreenivas Reddy  2 , Ashish Jain  1 , Bhushan Shah  3
Affiliations
Case Reports

Successful Management of Anomalous Lipton R-III Right Coronary Artery Chronic Total Occlusion

Ankit Gupta et al. Cureus. .

Abstract

Chronic total occlusion (CTO) of the coronary artery is a subset where cardiologists confront technical challenges most of the time during percutaneous coronary intervention (PCI). A congenital coronary anomaly is considered a critical challenge, especially when accompanied by CTO lesions. We report a case of a 64-year-old hypertensive and chronic smoker male who presented to our tertiary care center with chief complaints of Canadian Cardiovascular Society II angina. Coronary angiography revealed proximal right coronary artery CTO in a patient with an anomalous origin of coronary arteries arising from the right single sinus "Lipton R-III" which was managed successfully through PCI.

Keywords: angiography; anomalous coronary artery; chronic total occlusion; coronary artery anomaly; percutaneous coronary intervention; single ostium; single sinus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Angiogram showing anomalous left (red arrow) and right (green arrow) coronary arteries arising from a single sinus (blue arrow), normal left main, diffused plaque in the LAD artery (yellow arrow), plaque at the proximal LCX artery (white arrow), ostial obtuse marginal branch, dominant RCA with existence of CTO at proximal RCA and retrogradely filling from the left coronary arteries
RCA: right coronary artery, CTO: chronic total occlusion, LAD: left anterior descending, LCX: left circumflex
Figure 2
Figure 2. A computed tomography angiogram showing anomalous left (red arrow) and right (green arrow) coronary arteries arising from a single sinus (blue arrow), LAD artery (yellow arrow), and LCX artery (white arrow)
LAD: left anterior descending, LCX: left circumflex
Figure 3
Figure 3. Angioplasty showing the Fielder XT wire (red arrow) used to cross the lesion and another wire (blue arrow) placed in the aorta. The green arrow shows the RCA
RCA: right coronary artery
Figure 4
Figure 4. Angioplasty showing (A) a 3.0 × 48 mm VIVO ISAR drug-eluting stent negotiated and deployed in the proximal to mid-RCA at 12 atm and (B) post-dilatation in the proximal to mid-RCA using a 3.25 × 12 mm Pipit NC balloon at 12–14 atm
RCA: right coronary artery
Figure 5
Figure 5. Post-stent thrombolysis in myocardial infarction flow
See this image and copyright information in PMC

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