Catheter-directed angiography remains the gold standard both for diagnosis and treatment of a coronary artery anomaly (CAA). CAA intervention continues to remains a complicated task even in the hands of experienced operators. The greatest challenges faced in the management of CAAs are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful CAA intervention. We discuss a series of cases where CAAs were encountered during angiography and review the diverse technical difficulties faced by operators during interventions of these congenital anomalies.