Percutaneous Coronary Intervention in an Isolated Branch of the Right Coronary Artery Anomalously Originating from the Mid-Left Anterior Descending Artery

Abstract

Video 1). The patient was diagnosed with stable angina pectoris. Because the patient was relatively young, complete revascularization to be a preferable approach. The syntax score was 11, and the treatment plan was discussed within the cardiology team and a decision to perform percutaneous coronary intervention (PCI) was made. It is rare to detect single coronary arteries during angiography and rarer still to detect abnormal origins of the right coronary artery (RCA) from the left anterior descending artery (LAD). A 49-year-old man with hypertension and hyperlipidemia presented to our hospital with a chief complaint of exertion-induced chest pain in the month leading up to presentation. Inverted T-waves were seen in leads V1–V5 on the electrocardiogram, and coronary computed tomography (CT) demonstrated that all three major coronary arteries originated from the same ostium in the left sinus of Valsalva. An anomalous RCA arose from the LAD as a separate branch and then coursed anteriorly down the right atrioventricular groove. Coronary angiography showed a high-grade stenosis (>90%) in the proximal LAD and mid-distal RCA. The cardiology team discussed the treatment plan and consequently performed complete revascularization with percutaneous coronary intervention (PCI). The approach was successful, and at the 10-month follow-up, the patient was symptom-free and coronary CT showed no restenosis.