Coronary Intervention in Separate Origin of Left Anterior Descending and Left Circumflex Coronary Artery OD01-OD03
Dr. Debasish Das,
Associate Professor, Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Coronary anomalies are not commonly encountered in routine clinical practice. This case report is of a 55-year-old female who presented with effort angina, Canadian Cardiovascular Society (CCS) class II, since last six months with shortness of breath. Echocardiography (ECG) revealed the presence of Non ST Elevation Myocardial Infarction (NSTEMI) and the presence of no Regional Wall Motion Abnormality (RWMA), with normal left ventricular systolic function. Right transradial coronary angiogram revealed the presence of separate origin of Left Anterior Descending (LAD) and Left Circumflex (LCX) coronary artery. Although separate origin of LAD and LCX is the most common benign coronary anomaly noted in clinical practice, interestingly both coronary arteries in this case were harboring significant atherosclerotic occlusion and were successfully revascularised with Drug Eluting Stents (DES). Coronary intervention in separate origin of LAD and LCX requires special maneuvers during guide catheter management for percutaneous intervention. Clockwise rotation of the guide catheter to selectively engage the LCX and anticlockwise rotation of the guide catheter to selectively engage the LAD is the key for procedural success during coronary intervention. This case is unique and the first to describe the separate origin of LAD and LCX presenting as NSTEMI with critically obstructive Coronary Artery Disease (CAD) in both of them and age being the only conventional cardiac risk factor behind it.