Anomalous connection of the right coronary artery with interarterial course: Preliminary prospective experience of stenting in a selected adult population

Abstract

Anomalous connections of the coronary arteries (ANOCOR) with interarterial course raise therapeutic problems. Current guidelines recommend a surgical repair for right ANOCOR with evidence of ischemia. The lack of controlled studies and the scarcity of long-term data may explain an underutilization of surgical treatment. A percutaneous approach may provide an interesting alternative in a selected adult population. To assess the feasibility and safety of preaortic segment stenting in right ANOCOR with interarterial course. Stenting was proposed according to predefined criteria (age > 30 years, symptoms or documented ischemia, no history of aborted sudden death, ostial ovoid shape) for patients referred to an expert group. All patients underwent selective coronary angiography and coronary computed tomography. Evaluation by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was recommended. Ten patients were prospectively included between 2014 and 2016, mean age 56 years (35–81). Two patients had acute coronary syndrome, five had stable angina, two were asymptomatic with positive stress test and one had syncope. An intramural segment was identified in half of the patients. Stenting was successful with residual angiographic stenosis < 50% in all procedures, 90% of drug-eluting stents, mean fluoroscopic time of 18 min, 70% of IVUS or OCT guidance, mean troponin at 24 hours of 0.58 μg/L and no periprocedural complication. Follow-up at 6 months was uneventful in all but one patient requiring a new hospitalization at 5 months for persistent angina reported to a vasospastic angina ( Fig. 1 ). Preaortic segment stenting of right ANOCOR with interarterial course appears feasible and safe in this preliminary experience. A longer follow-up and a more important population are needed to know whether this technique is suitable for a next therapeutic algorithm.