An Unusual Case of Right Anterior Descending Coronary Artery.

The left anterior descending coronary artery (LAD) arises from the left coronary sinus about 10-12 mm above the annular plane and traverses down the interventricular groove. With deep septal and diagonal branches, it supplies the left side of the heart. Here, we describe an extremely rare case of anomalous origin of the LAD from the right coronary artery, which courses epicardially over the right side of the heart with its ramifying branches, which can be described as the "right anterior descending coronary artery (RAD)."

An Unusual Case of Long-Segment Dissection of the Left Anterior Descending Coronary Artery During Osteoproximal Chronic Total Occlusion Intervention.

Coronary artery dissection can occur after post-balloon inflation; however, a very long-segment coronary dissection (>50 mm) is a rare occurrence during routine coronary interventions. Here, we report an extremely rare case of long-segment coronary dissection in the left anterior descending coronary artery (LAD) induced during antegrade revascularization of chronic total occlusion of osteoproximal LAD with stiffer Gaia II wire. The patient had excruciating angina with hemodynamic collapse and acute pulmonary edema; the patient was rescued with long-segment coronary revascularization.

A Single Coronary Artery From the Left Coronary Sinus: The Continuing Conundrum.

It is extremely rare to come across a single coronary artery during routine interventional cardiology practice. The incidence of single coronary arteries increases across congenital heart diseases. We report an extremely rare case of a single coronary artery arising from the left coronary sinus in an octogenarian presenting with anterior wall non-ST elevated myocardial infarction (NSTEMI) secondary to atherosclerotic occlusion of the proximal left main coronary artery (LMCA). It is often difficult to selectively engage a single coronary artery due to anomalous origin from the sinus; nonselective coronary sinus injection often suffices in visualizing the single coronary trunk dividing into left and right coronary arteries besides demonstrating the associated route and atherosclerotic anomalies.

Primary Percutaneous Coronary Intervention of Acute Thrombotic Occlusion of a Low-Lying Tortuous Right Coronary Artery With a Multipurpose Catheter in an Octogenarian.

Right coronary artery intervention is usually accomplished with a Judkins right (JR) coronary guide catheter. Abnormal right coronary artery take-off from the right coronary sinus poses difficulty in engaging the right coronary artery with a conventional JR guide catheter. We report a rare case of primary percutaneous intervention of the right coronary artery which was performed with a multipurpose catheter as the patient had an extremely low-lying coronary artery from the coronary sinus where conventional catheters could not engage the right coronary artery in an octogenarian with acute inferior wall ST-elevation myocardial infarction in cardiogenic shock.