A rare case of dual left anterior descending artery type 4 in inferior myocardial infarction patient: a case report

Abstract

Background: This case highlights a type 4 dual left anterior descending coronary artery anomaly, identified incidentally during coronary angiography.

Case summary: A 51-year-old male patient presented with acute myocardial infarction, which was successfully treated with thrombolysis and percutaneous coronary intervention. Angiography revealed an anomalous origin of the left anterior descending artery (LAD) from the right coronary artery. Stenting was performed on the right coronary artery and the right posterior descending artery branch.

Discussion: Type 4 dual LAD is a rare coronary anomaly with potential clinical risks, including sudden cardiac death due to its course between major arteries. Variations in the structure of coronary arteries can present challenges for interventional cardiologists when conducting percutaneous coronary interventions. Accurate coronary anatomy assessment via angiography and computed tomography coronary angiography is crucial for successful percutaneous coronary intervention and surgical planning. Although uncommon, the dual LAD type 4 anomaly is a significant coronary artery variation that interventional cardiologists must consider due to its impact on prognosis and long-term treatment strategies.

Keywords: Cardiac imaging; Case report; Dual LAD; Myocardial infarction; Percutaneous coronary intervention.

Figure 1

(A) Left anterior oblique cranial view shows a short left anterior descending artery with small septal branches and diagonal arising from the same. The left circumflex is normal. (B) Left anterior oblique cranial view showing a long left anterior descending artery is seen arising from the proximal right coronary artery, as it traverses across towards the anterior interventricular sulcus. A diagonal branch arising from long left anterior descending artery is also seen and septal branches. (C) Left anterior oblique caudal view showing a proximal right coronary artery lesion, located just beyond the origin of the long left anterior descending artery. (D) Left anterior oblique caudal view displaying a proximal right coronary artery lesion, located just beyond the origin of the extended left anterior descending artery. (E) Right anterior oblique caudal view showing long course of proximal part of long left anterior descending artery as it traverses across towards the anterior interventricular sulcus. A diagonal branch arising from long left anterior descending artery is also seen. (F) Right anterior oblique cranial shows a short left anterior descending artery with small septal branches and diagonal arising from the same. S-LAD: short Left anterior descending artery; L-LAD: long Left anterior descending artery; S: septal branches; D: diagonal branches; RCA: right coronary artery; LCX: left circumflex.

Figure 2

(A, B) Volume rendering computed tomography coronary image shows a type 4 dual left anterior descending artery. The short left anterior descending artery gives off the first major diagonal branch and ends in the proximal anterior interventricular groove. The aberrant long left anterior descending artery origin from the right coronary artery ostium is seen taking a pre-pulmonic course and enters the mid-anterior interventricular groove. LMCA: left main coronary artery; LAD1: short Left anterior descending artery; LAD2: Long left anterior descending artery; RCA: right coronary artery; LCX: left circumflex.