Korean Circ J.  2008 Mar;38(3):179-183. 10.4070/kcj.2008.38.3.179.

Two Cases of Successful Primary Percutaneous Coronary Intervention in Patients With an Anomalous Right Coronary Artery Arising From the Left Coronary Cusp

• Kim JY
• Yoon SG
• Doh JH
• Choe HM
• Kwon SU
• Namgung J
• Lee SY
• Lee WR

• KMID: 2225836
• DOI: http://doi.org/10.4070/kcj.2008.38.3.179

Abstract

An anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital anomaly. Because of the unusual location and the noncircular luminal orifice of this anomaly, cannulation of this artery during coronary angiography and percutaneous coronary intervention (PCI) poses significant technical difficulties when using the currently available guiding catheters. Primary PCI should be performed as quickly as possible when a patient displays this condition. When we face the situation of an anomalous artery during primary PCI, it takes a much longer time to open the occluded artery. We report here on two cases of successful primary PCI with using manually manipulated catheters and Ikari type guiding catheters in 2 patients who both had an anomalous RCA arising from the left coronary cusp.

Keyword

Coronary vessel anomalies; Percutaneous transluminal coronary angioplasty; Tomography, X-ray computed

MeSH Terms

Angioplasty, Balloon, Coronary
Arteries
Catheterization
Catheters
Coronary Angiography
Coronary Vessel Anomalies
Coronary Vessels
Humans
Percutaneous Coronary Intervention
Phenobarbital
Tomography, X-Ray Computed
Phenobarbital

Figure

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  Fig. 1 An electrocardiogram showed ST segment elevation in the II, III and aVF leads.

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  Fig. 2 Baseline coronary angiogram showed an anomalous right coronary artery (RCA) ostium (small arrow) and subtotal occlusion of the mid-RCA (large arrow).

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  Fig. 3 5 French launcher EBU4 guiding catheter. Before: the natural shape of the EBU4 guiding catheter. After: the manually manipulated EBU4 guiding catheter (arrow) using a hair dryer. EBU: extra-backup.

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  Fig. 4 The final coronary angiogram showed a successfully implanted stent at the mid right coronary artery (arrow).

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  Fig. 5 The 64 slice multi-detector computed tomography (MDCT) showed an anomalous right coronary artery ostium (small arrow) and patent stent lumen (large arrow).

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  Fig. 6 An electrocardiogram showed ST segment elevation in the II, III and aVF leads.

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  Fig. 7 A: baseline coronary angiogram using a 6 French Heartrail Ikari right 1.5 guiding catheter showed an anomalous right coronary artery (RCA) ostium (small arrow) and total occlusion of the distal RCA (large arrow). B: 6 French Heartrail Ikari right 1.5 guiding catheter.

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  Fig. 8 The final coronary angiogram showed a successfully implanted stent at the distal right coronary artery (arrow).

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  Fig. 9 The 64 slice multi-detector computed tomography showed a patent stent lumen (arrows).

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