Primary percutaneous coronary intervention of an anomalous right coronary artery arising from the left coronary cusp using an undersized Judkins catheter: A case report

Introduction: To the best of the authors’ knowledge, very few publications are available which report on the prognostic significance of the culprit vessel in patients with ST elevation myocardial infarction treated with successful primary percutaneous coronary intervention. Aim: The aim of the authors was to obtain data on the significance of the culprit vessel in patients with ST elevation myocardial infarction treated successfully by primary percutaneous coronary intervention. Method: The authors performed a retrospective study in 10,763 patients with ST elevation myocardial infarction who underwent successful primary percutaneous coronary intervention. The culprit vessels were the left main artery, left anterior descendent artery, left circumflex artery, and right coronary artery. The authors constructed univariate survival curves for different culprit vessels and also performed multivariate modelling of time-to-death, controlling for age, sex, and comorbidities. Results: The majority of the culprit lesions were found in the left anterior descendent artery (44.3%), the right coronary artery (40.9%), and the left circumflex artery (13.7%). The culprit vessel was overall a highly significant (p<0.0001) factor of survival, with right coronary artery exhibiting a highly significantly better prognosis (hazard ratio 0.69, 95% CI 0.61–0.79, p<0.0001) and left main artery exhibiting a significantly worse prognosis (hazard ratio 1.56, 95% CI 1.04–2.35, p = 0.0321) than the reference vessel (left anterior descendent artery). Conclusion: These data demonstrate that the culprit vessel has independent prognostic significance. Orv. Hetil., 2016, 157(32), 1282–1288.

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Primary Percutaneous Coronary Intervention in Anomalous High Anterior Takeoff Right Coronary Artery

The Annals of Clinical and Analytical Medicine ◽

10.4328/jcam.3357 ◽

2014 ◽

Vol 5 (Supplement 4) ◽

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Percutaneous Coronary

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Balloon-Anchored CoKatte® for Successfully Delivering Balloons for an Occluded Anomalous Right Coronary Artery

International Journal of Angiology ◽

10.1055/s-0038-1669957 ◽

2018 ◽

Vol 27 (04) ◽

pp. 232-234

Author(s):

Hiroyuki Hikita ◽

Keiichi Hishikari ◽

Atsushi Takahashi ◽

Makoto Araki

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Intervention ◽

Effort Angina ◽

Percutaneous Coronary ◽

Coronary Cusp ◽

Guiding Catheter

AbstractPercutaneous coronary intervention (PCI) for anomalous right coronary artery (RCA), originating from the left coronary cusp is challenging, because of the difficulty in engaging the guiding catheter coaxially, and delivering balloons and stents. A 65-year-old man with effort angina underwent PCI for anomalous RCA. This report describes the method we used. Although, delivering the balloon was difficult in short of the guiding catheter's backup force, we finally succeeded by using one more guiding catheter and the balloon-anchored CoKatte®, a novel, straight 4.5-French child catheter, to strengthen the backup force.

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Left main-like bifurcation primary percutaneous coronary intervention case report: anomalous right coronary artery ostium from the left anterior descending

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa313 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-5

Author(s):

Julio I Farjat Pasos ◽

Jorge Padilla Ibarra ◽

Paolo Angelini ◽

Eduardo A Arias

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Single Coronary Artery ◽

Left Main ◽

Thrombotic Occlusion ◽

First Case ◽

Percutaneous Coronary

Abstract Background A single coronary artery ostium (SCAO) is estimated to be present in 0.066% of the general population. The proximal coronary course and the relationship with surrounding structures are related to malignant vs. benign prognoses. We present a case of SCAO with the right coronary artery (RCA) arising from the mid-left anterior descending (LAD), complicated by anterior and inferior STEMI because of acute thrombotic occlusion at the bifurcation and its percutaneous management. Case summary A 56-year-old male was admitted with sudden onset of resting chest pain. His ECG showed an anterior, inferior, and right ventricular STEMI. Via trans-radial access, coronary angiography showed significant stenoses at the left main and the circumflex but also a thrombotic occlusion at the proximal segment of the LAD while no RCA was seen. After crossing the LAD occlusion, the dominant RCA appeared from the mid-LAD. A provisional stent technique was performed achieving good results. Coronary computed tomography angiography showed an SCAO congenital anomaly with a patent stent in the bifurcation accompanied by diffuse coronary artery disease causing mild stenosis of the left main, proximal, and distal circumflex. Discussion The RCA arising from the mid-LAD with pre-pulmonic course has been described in only 37 cases. One reported an LAD/RCA bifurcation treatment with two stents technique in a stable scenario. The present is the first case reported of an acute thrombotic occlusion of an LAD/RCA bifurcation clinically resulting in a left main equivalent STEMI treated successfully with primary percutaneous coronary intervention using a bifurcation technique.

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