Primary Stenting of an Anomalous Left Anterior Descending Coronary Artery Originating From the Proximal Right Coronary Artery in a Patient With Acute Non–ST-Elevation Myocardial Infarction
An isolated single coronary artery is a rare congenital anomaly with an incidence of 0.03% to 0.4% and an uncommon finding (0.6% to 1.2%) in patients undergoing cardiac catheterization. An anomalous origin of the left anterior descending coronary artery (LAD) from the right proximal coronary artery (RCA) is rare, found in 1.2% to 6.1% of all coronary anomalies. A 44-year-old patient with this anomaly developed acute non–ST-elevation myocardial infarction during exercise and was admitted to a hospital. Detection of creatine kinase-MB and troponin I elevation led to this patient being transferred to the university hospital for cardiac catheterization. Coronary angiography revealed the presence of an isolated single coronary artery, with the left coronary artery (LCA) originating from the RCA (Figure 1). A singular 80% Ambrose’s type II excentric lesion indicating plaque rupture and residual thrombus was found in the middle portion of the LAD and was considered to be the culprit lesion (Figure 2). The RCA and left circumflex artery were free of any significant obstruction. In the absence of a left coronary ostium, the patient underwent successful “retrograde” LAD stenting via the origin of the right coronary artery (Figure 3). The procedure eliminated the ischemia. Until now, no report of percutaneous transluminal coronary angioplasty and stenting in a patient with this anomaly has been published.