Anomalous Coronary Artery From the Opposite Sinus (ACAOS): Technical Challenges During Percutaneous Coronary Intervention

Abstract

Anomalies of the coronary arteries are reported in 1-2% of patients among diagnostic angiogram. Ectopic origin of right coronary artery (RCA) from opposite sinus is one of the most common and they are mainly benign, but at times may be malignant. We report a case of a 69-year-old male who underwent early invasive percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (NSTEMI) where RCA arising from left sinus at the root of left main artery was culprit and various technical challenges were encountered while intervening in form of cannulation to tracking of hardwares. RCA was cannulated with floating wire technique using hockey stick guide catheter and revascularized by deployment of 3.5 × 38 mm Promus Premier Everolimus eluting stent (Boston Scientific, USA). To the best of our knowledge, this is the first ever report of ectopic RCA being revascularized by using hockey stick catheter.

Anomalous Coronary Arteries: A Case of Rare and Incidental Findings

“…For ACAOS with LMCA from the RSOV, the course of the LMCA is best visualized in the right anterior oblique (RAO) caudal view, and its course may run inter-arterial, retro-aortic, septal, or anterior-pulmonic [ 8 ]. Judkins Right 4 (JR4) and hockey stick catheters can be used in these scenarios to engage the RCA and with rotation, the LMCA [ 9 ].…”

Anomalous Aortic Origin of Coronary Arteries from the Opposite Sinus: A Case Report

“…After gauging whether the ACA is benign or malignant in nature, a decision on whether to pursue surgical or conservative management, which includes medical treatment or percutaneous coronary intervention (PCI) in case of obstructive coronary artery disease (CAD), can be taken. Patients like the one above who presented with ischemia-like symptoms from obstructive coronary disease and favorable anatomy of the anomalous LAD arising from a separate ostium with no interarterial or intramural course may be managed non-surgically with a PCI [ 13 ].…”

Percutaneous coronary intervention of an anomalous coronary chronic total occlusion: The added value of three‐dimensional printing

“…A brief literature review yielded numerous case reports and a few case series describing successful PCI of RCA-LSV lesions. [4][5][6][7][8][9][10] Throughout these publications, the authors unanimously emphasized the key role of appropriate guide catheter selection for successful intervention, and many provided the sequence of catheters that were attempted prior to successful engagement. A couple of case series suggested classification of the anatomical location of the anomalous ostium could help in determining which catheter to use, although consecutive cases still required multiple catheter attempts.…”

“…A brief literature review yielded numerous case reports and a few case series describing successful PCI of RCA‐LSV lesions . Throughout these publications, the authors unanimously emphasized the key role of appropriate guide catheter selection for successful intervention, and many provided the sequence of catheters that were attempted prior to successful engagement.…”