Angioplasty with stenting of anomalous connections of the coronary arteries: A potential alternative to surgery. Results of the prospective ANOCOR stenting registry

Abstract

Anomalous connections of the coronary arteries (ANOCOR) with an interarterial course raise therapeutic problems. Current guidelines recommend a surgical repair regardless of age for right ANOCOR with ischemic symptoms or documented myocardial ischemia. The lack of controlled studies explain some therapeutic reluctances. A percutaneous approach may provide an interesting alternative in a selected adult population. To assess the feasibility and safety of interarterial segment stenting in right ANOCOR. Stenting was proposed according to predefined criteria (age > 20 years, ischemic symptoms or documented myocardial ischemia, slit-like ostium) for patients referred to an expert group. All patients underwent selective coronary angiography and coronary computed tomography (CT). Evaluation by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was recommended. A systematic coronary CT and functional test were proposed at 6-12 months. Clinical follow-up was scheduled at 6, 12 and 60 months. Sixteen patients (mean age 52 years) were prospectively included between 2014 and 2019. Fourteen patients were symptomatic and two patients were asymptomatic with documented myocardial ischemia. Stenting was successful in all procedures with mean stent diameter of 3.4 mm, mean stent length of 25 mm, mean fluoroscopy time of 19 min, > 80% of IVUS or OCT guidance, and mean troponin at 24 hours of 0.51 μg/L. No in-hospital complication occurred. No extrinsic stent compression was observed on coronary CT follow-up. Clinical follow-up at 12 months was uneventful in all but three patients: one patient with persistent angina reported to vasospastic angina and two patients with intrastent restenosis treated by balloon angioplasty. Interarterial segment stenting appears feasible and safe. More important population and longer follow-up are needed to include this approach in a future management algorithm for patients with ANOCOR.