Anomalous origin of culprit coronary artery in acute coronary syndromes: importance of cannulation

    Authors

    Keywords

    acute coronary syndrome, anomaly, percutaneous coronary intervention

    DOI

    https://doi.org/10.15836/ccar2018.390

    Full Text

    Objective: Anomalous origin of coronary arteries in acute coronary syndrome (ACS) is not only a curiosity, but represent also a challenge for adequate cannulation of the culprit coronary artery and successful percutaneous coronary intervention (PCI) that will lead to the patient’s final stabilization. We present a series of cases within Croatian Primary PCI Network and experience in University Hospital Dubrava with guiding catheter selection in the case of anomalous coronary circulation. Patients and Methods : Data on anomalous coronary circulation in patients treated for ACS over a period of 12 months and PCI strategies were analyzed. Results: Out of 346 patients with ACS treated with PCI between September 2017 and September 2018, the anomalous origin of culprit coronary artery was found in 6 (1.7%) patients. In 3 patients, the circumflex artery originated from the right coronary artery, 1 patient had anomalous solitary coronary artery from the right coronary sinus, 1 patient had an anomalous origin of the right coronary artery in the superior/posterior position above the left coronary sinus with coronary artery passing between the pulmonary artery and the aorta, and in 1 of the patients there was high atypical origin of the left coronary artery in ​​the anterior aortic wall above the left coronary sinus. The MPA catheter showed optimal support to intervention in all cases of circumflex artery originating from the right coronary artery as well as in the case of the solitary coronary artery. In the other 2 patients, AL2 guiding catheter provided optimal cannulation. In 4/6 cases successful PCI was performed, one patient was sent to cardiac surgery, and one was treated conservatively. Conclusion: The anomalous origin of the culprit coronary artery in ACS, albeit very rare, can make PCI difficult or impossible because standard guiding catheters do not usually allow successful cannulation and support ( 1 ). MPA and AL2 catheters proved to be appropriate choice for most cases of anomalous coronary artery origin in our patients.

    Cardiologia Croatica
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    Anomalous origin of culprit coronary artery in acute coronary syndromes: importance of cannulation

    Extended Abstract
    Issue11-12
    Published
    Pages390
    PDF via DOIhttps://doi.org/10.15836/ccar2018.390
    acute coronary syndrome
    anomaly
    percutaneous coronary intervention

    Authors

    Irzal Hadžibegović*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Mario SičajaORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Ognjen ČančarevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Miroslav RagužORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Boris StarčevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Objective: Anomalous origin of coronary arteries in acute coronary syndrome (ACS) is not only a curiosity, but represent also a challenge for adequate cannulation of the culprit coronary artery and successful percutaneous coronary intervention (PCI) that will lead to the patient’s final stabilization. We present a series of cases within Croatian Primary PCI Network and experience in University Hospital Dubrava with guiding catheter selection in the case of anomalous coronary circulation. Patients and Methods : Data on anomalous coronary circulation in patients treated for ACS over a period of 12 months and PCI strategies were analyzed. Results: Out of 346 patients with ACS treated with PCI between September 2017 and September 2018, the anomalous origin of culprit coronary artery was found in 6 (1.7%) patients. In 3 patients, the circumflex artery originated from the right coronary artery, 1 patient had anomalous solitary coronary artery from the right coronary sinus, 1 patient had an anomalous origin of the right coronary artery in the superior/posterior position above the left coronary sinus with coronary artery passing between the pulmonary artery and the aorta, and in 1 of the patients there was high atypical origin of the left coronary artery in ​​the anterior aortic wall above the left coronary sinus. The MPA catheter showed optimal support to intervention in all cases of circumflex artery originating from the right coronary artery as well as in the case of the solitary coronary artery. In the other 2 patients, AL2 guiding catheter provided optimal cannulation. In 4/6 cases successful PCI was performed, one patient was sent to cardiac surgery, and one was treated conservatively. Conclusion: The anomalous origin of the culprit coronary artery in ACS, albeit very rare, can make PCI difficult or impossible because standard guiding catheters do not usually allow successful cannulation and support ( 1 ). MPA and AL2 catheters proved to be appropriate choice for most cases of anomalous coronary artery origin in our patients.