Anomalous origin of culprit coronary arteries in acute coronary syndromes
Abstract
Background: The aim of the study was to describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently.
Methods: Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS.
Results: Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, left coronary artery (LCA) originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-segment elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS- -patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non- STEMI). In the remaining patients PCI was successfully performed.
Conclusions: The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.
Keywords: anomalous origin culprit coronary arterypercutaneous coronary interventionacute coronary syndrome
References
- Amado J, Carvalho M, Ferreira W, et al. Coronary arteries anomalous aortic origin on a computed tomography angiography population: prevalence, characteristics and clinical impact. Int J Cardiovasc Imaging. 2016; 32(6): 983–990.
- Graidis C, Dimitriadis D, Karasavvidis V, et al. Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. BMC Cardiovasc Disord. 2015; 15: 112.
- Karur S, Patra S, Shankarappa RK, et al. Percutaneous coronary intervention in patients with anomalous origin of coronary artery presenting with acute coronary syndrome: A case series. J Cardiovasc Dis Res. 2013; 4(3): 204–208.
- Lee OhH, Yoon GS, Choi SH, et al. Anomalous origin of the left circumflex artery from the right sinus of valsalva: non-ST-segment elevation myocardial infarction. Intern Med. 2015; 54(9): 1053–1056.
- Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992; 20(3): 640–647.
- Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990; 21(1): 28–40.
- Vakili H, Khaheshi I, Memaryan M, et al. Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report. Rom J Intern Med. 2016; 54(4): 247–249.
- Maagh P, Wickenbrock I, Prull MW, et al. Percutaneous coronary intervention in patients with acute myocardial infarction due to congenital coronary anomalies: technical skills and clinical outcome. Acute Card Care. 2011; 13(3): 148–154.
- Shah RM, Patel D, Abbate A, et al. Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis. Catheter Cardiovasc Interv. 2016; 88(7): 1027–1033.
- Pristipino C. Radial versus femoral access in ACSs. Lancet. 2011; 378: 661.
- Elmahdy MF, ElMaghawry M, Hassan M, et al. Comparison of safety and effectiveness between right versus left radial arterial access in primary percutaneous coronary intervention for acute ST segment elevation myocardial infarction. Heart Lung Circ. 2017; 26(1): 35–40.
- Hamood H, Makhoul N, Grenadir E, et al. Anchor wire technique improves device deliverability during PCI of CTOs and other complex subsets. Acute Card Care. 2006; 8(3): 139–142.
- Keeley EC, Grines CL. Scraping of aortic debris by coronary guiding catheters: a prospective evaluation of 1,000 cases. J Am Coll Cardiol. 1998; 32(7): 1861–1865.
- Núñez-Gil IJ, Bautista D, Cerrato E, et al. Registry on Aortic Iatrogenic Dissection (RAID) Investigators. Incidence, Management, and Immediate- and Long-Term Outcomes After Iatrogenic Aortic Dissection During Diagnostic or Interventional Coronary Procedures. Circulation. 2015; 131(24): 2114–2119.
- Matsumoto M, Tamanaha Y, Tsurumaki Y, et al. GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of a Single Coronary Trunk Arising from the Ascending Aorta. Case Rep Cardiol. 2016; 2016: 8790347.
- Boukhris M, Azzarelli S, Tomasello SD, et al. The guideliner catheter: a useful tool in the armamentarium of the interventional cardiologist. J Tehran Heart Cent. 2015; 10(4): 208–214.
