By Deepak Natarajan
Monday, February 26, 2007, www.tctmd.com
Deepak Natarajan MD, DM
Indraprastha Apollo Hospitals,New Delhi
Departments of Cardiology
Indraprastha Apollo Hospitals, New Delhi, India
A 66 year old hypertensive lady had undergone stenting of her mid right coronary artery (RCA) in 2001. She was on eltroxin for hypothyroidism and was admitted in the ER this time for chest pain at rest and on exertion for the preceding 2 weeks.
- Normal left anterior descending artery (LAD) (Figure 1).
- Normal right coronary artery (RCA) (Figure 2).
- The left circumflex (LCX) artery was anomalous and was seen to be arising from the right coronary sinus very close to the origin of the RCA and had a tight 75% ostial stenosis (Figure 3).
The LCX was canalized with a 6Fr AR1 guiding catheter, and a 0.0014″ All Star guidewire was advanced across the LCX lesion (Figure 4). Direct stenting was done using a Multilink Vision bare metal stent 3x12mm at 16atm (Figure 5). The patient had been maintained on nitroglycerin infusion throughout the procedure and received a bolus of eptifibatide immediately before stenting.
TIMI 3 flow was achieved and there was no residual stenosis (Figure 6).
Coronary artery anatomic variations are uncommon and have been seen in approximately 0.6-1.6% of patients undergoing coronary angiography. The aberrant LCX from the RCA or the right coronary sinus is the most common anomaly observed and usually discovered by chance during coronary angiography or at autopsy. It is considered benign as it causes no myocardial compromise. However, it becomes important for the cardiac surgeon in case of aortic valve replacement. In the event of substantial atherosclerosis, the presentation may be as an acute myocardial infarction or unstable angina, as in this case. Percutaneous coronary intervention may be simple and effective in both instances.
Conflict of Interest: