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Symptomatic Anomalous Coronary Artery Origin Diagnosis and Interventions

https://e-kcj.org The anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) is a rare coronary artery anomaly which potentially may cause coronary ischemia when an aortic intramural course of the vessel is present.1) When ischemia caused by a phasic compression of the intramural decourse is confirmed, stenting or surgical un-roofing are generally proposed. A 47-year-old hypertensive man with acute coronary syndrome and ST changes in the inferior-lateral wall underwent emergent coronary angiography. The left circumflex presented a sub-occlusive lesion which was treated with a III-generation drug-eluting stent (DES). The right coronary artery (RCA) originated from the opposite sinus with a decourse which appeared closed to the left stem, anterior to the aorta with no impingement (Figure 1). A computed tomography (CT) angiographic scan failed to clearly demonstrate an intramural course (Figure 2). Because of a residual thoracic discomfort and abnormal electrocardiogram, a new transthoracic echocardiogram was performed in order to ruling out eventual procedure-related complications. An intramural decourse of the proximal portion RCA was Korean Circ J. 2018 May;48(5):442-445 https://doi.org/10.4070/kcj.2018.0025 pISSN 1738-5520·eISSN 1738-5555