Coronary artery anomalies, which are rare and asymptomatic, are usually detected incidentally during angiography or autopsy. The incidence has been estimated as 1-2% in the adult population. We would like to share the percutaneous intervention to the patient having non-ST elevation myocardial infarction (Non- STMI) with anomalous origin of the right coronary artery.
A 43-year-old man was admitted to our emergency department with chest pain and numbness in his right arm for 12 hours. He had no risk factor for coronary artery disease in his medical history. His physical examination was normal. His blood pressure was 110/70 mmHg and heart rate was 60/min. In his ECG ST depression was detected in the leads of V3-V6, DII-DIII and AVF (Figure 1). Troponin-I level was measured as 8.5 ng/ml. The patient was taken to the catheter laboratory with the diagnosis of non-STMI. The patient was pre-medicated with nitrolingual nitrate (5 mg), acetylsalicylic acid (300 mg) and unfractionated heparin (5000 U). Coronary angiography revealed that left main coronary artery, left anterior descending artery and circumflex coronary arteries were normal (Figure 2). However, RCA could not appear clearly and after intense opaque material it was realized that RCA was originated from somewhere close to left system (Figure 3). Then RCA image could be taken by using an AL-1 catheter and stenosis at two points was detected at the middle region and proximal region of RCA (Figure 4). This stenosis wasopened by a stenting procedure (Figure 5). During the follow-up the patient had no chest pain and was discharged with medical treatment and follow up.
We would like to show that rare coronary artery anomalies can be displayed by the appropriate catheter, and stent procedures can also be performed. It should be kept in mind that procedures thought to be difficult can be realized with the appropriate catheter and manipulations even if the coronary arteries originate from different sinus valsava.
