Dual Left Anterior Descending, Interarterial Principal LAD, and Anomalous Circumflex, Presenting With Acute Coronary Syndrome

Abstract

Coronary artery anomalies are rare, but even rarer are the constellations of coronary anomalies. This article describes a very rare constellation of anomalous coronary arteries identified in the context of a non−ST-elevation myocardial infarction (NSTEMI). In addition to describing this challenging case, this article provides tips and tricks for operators on catheter selection to optimize the engagement of these atypical coronary arteries and highlights the high-risk features of coronary anomalies based on the arterial course, ostium shape, and vessel size.