The posterior descending artery (PDA) supplying the posterior one-third of the inter-ventricular septum usually arises from the right coronary artery (RCA) or the left circumflex artery (LCX). PDA arising from the left anterior descending artery (LAD) is an extremely rare anomaly. Here we report a rare type of left dominant circulation in which a large LAD is continuing as PDA after winding round the apex in the presence of a diminutive RCA. Such a large LAD continuing as PDA is referred as “hyperdominant” or “superdominant”. A 32–year-old male chronic smoker presented with acute onset retrosternal pain of 4 h duration with profuse sweating in primary health center with electrocardiography (ECG) changes in inferior leads and was thrombolysed with intravenous streptokinase 15 lacs IU over one hour and was referred to our center for further management and coronary intervention. Coronary angiogram revealed PDA as a continuation of the LAD beyond the crux and a non-dominant right coronary as well as LCX. The LAD had plaque in mid-LAD course. Intravascular ultrasound study (IVUS) showed insignificant plaque in mid-LAD (30%). Hence, we decided to keep him on medical therapy only.
BackgroundA chronic total occlusion (CTO) is defined as an angiographically documented or clinically suspected complete interruption of antegrade coronary flow (Thrombolysis in Myocardial Infarction (TIMI)-0 flow) of greater than 3 months standing. Coronary CTOs represent the most technically challenging lesion subset that interventional cardiologists face. CTOs are identified in up to one third of patients referred for coronary angiography and remain seriously undertreated with percutaneous techniques. Decision to treat or not to treat a CTO is always confusing. This is an attempt to provide clinical profile of patients having totally occluded coronary arteries and their natural history.MethodsThe observational study was carried out in tertiary health center in Mumbai. Totally 117 patients who had CTO on angiography were selected. Their clinical presentation and angiography correlation was done and results were analyzed.ResultsOut of a total of 117 patients, 86 (73.50 %) were males, female 31(26%). All of the patients studied were above 40 years. Age group 40 - 49 years had 25 (21.36%) patients, 50 - 59 years had 32 (27.35%), 60 - 69 years had 43 (36.75%), > 70 years had 17 (14.52%) patients. Smoking as a risk factor was present in 32 (27.35%), tobacco in 45 (38.46%), alcohol in six (5%), no addictions in 35 (29.91%) patients. Diabetes in 63 (53.84%), hypertension in 78 (66.67%) patients, both were present in 49 (41.88%), dyslipidemia in 37 (31.62%) patients. Sixty-three (53.84 %) patients presented with unstable angina (UA)/non ST elevated myocardial infarction (NSTEMI), 32 (27.35%) with chronic stable angina (CSA), ST elevated myocardial infarction (STEMI) in 22 (18.80%). History of prior myocardial infarction (MI) was present in 36 (30.76%), prior coronary artery bypass graft (CABG) in nine (7.6%), prior percutaneous intervention (PCI) in 18 (15.38%). Triple vessel disease (TVD) in 38 (32.47%), double vessel disease (DVD) in 53 (45.29%), single vessel disease (SVD) in 26 (22.22%) patients. Left anterior descending artery (LAD) CTO was present in 40 (34.18%), right coronary artery (RCA) in 61 (52.14%), left circumflex artery (LCX) obtuse marginal (OM) in 16 (13.67%) patients.ConclusionsPatients having CTO of coronary arteries are mostly above age of 40 years. Most common age group was 60 - 69 years. It was most common in males than females. Tobacco chewing was more commonly associated followed by smoking. Hypertension and diabetes were strongly associated with CTO. Most patients presented with unstable angina/NSTEMI followed by chronic stable angina. Old MI was present in one third of patients. Most common artery to be affected was RCA followed by LAD.
Coronary trifurcation lesions are a complex group of lesions. Percutaneous intervention of such trifurcation lesions which involve left anterior descending artery, left circumflex artery and RAMUS artery is difficult task. Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a main trunk. The approach to treat trifurcation lesions has not been standardized. We describe a technique to percutaneously treat this lesion using routine day-to-day hardware and a unique two guide catheter technique. We present a case admitted in our hospital with unstable angina. CAG done suggestive of triple vessel disease and later PTCA was done. Staged PTCA was planned Initially RCA and subsequently Trifurcation PTCA was done for left system.No postprocedural complication was observed and then patient was discharged on third day.
Coronary artery anomalies are clinically important as there have been reports of sudden death and fatal and non-fatal myocardial infarction associated with exercise in persons with certain types of unusual coronary anatomy. A circumflex artery originating from an ostium apart from the left main artery is one of the most common coronary artery anomalies. However, the dual origin of the circumflex artery is an extremely rare anomaly. We describe a 45-year-old female patient admitted to our tertiary care hospital with complaints of exertional dyspnea with a positive treadmill test. Angiography revealed twin circumflex arteries: one from the left main artery and the other from the proximal right coronary artery with no significant obstructive coronary lesions; hence, advised medical management.
Chronic mesenteric ischemia (intestinal angina) is a condition that is caused by stenosis or occlusion of the mesenteric arteries (Superior mesenteric artery, inferior mesenteric artery and celiac artery) and usually manifest as abdominal pain which is usually post - prandial in nature. If plaque or lesion in an artery supplying the intestines narrows the vessel so severely that sluggish blood flow causes a clot, blood flow through that artery can become completely blocked, which can lead to ischemia .While surgical revascularization has been the standard treatment for symptomatic patients in past , recent advances in interventional devices and techniques have made endovascular treatment easily available and effective treatment. Endovascular treatment is considered as minimally invasive means of obtaining good long-term results. The Coronary arteries are common hiding places for cholesterol-filled plaque and blood clots. Plaque can limit blood flow during exercise or stress, causing the chest pain or pressure known as angina. Clots may completely block blood flow, causing a heart attack or cardiac arrest. These two leading perpetrators can do similar things elsewhere in the body. When they interfere with blood flow to the digestive system, the effects can range from a stomach ache after every meal to a life threatening emergency. We report a similar case who present with unstable angina. During hospitalization he was having persistent abdominal pain and who was investigated with CT abdomen and later Angioplasty was done which further showed significant benefit to patient.
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