Ektopowe, wysokie odejście prawej tętnicy wieńcowej — problemy techniczne w trakcie przezskórnej rewaskularyzacji wieńcowej

Abstract

Anomalies of the coronary arteries are reported in 1–2% of patients who undergo a diagnostic angiogram. An ectopic origin of the right coronary artery from the opposite sinus is one of these anomalies, and while most are benign, at times it may be malignant. We report the case of a 43-year-old female who underwent primary percutaneous coronary intervention for acute inferior wall myocardial infarction where an ectopically arising right coronary artery (RCA) with abnormally high take-off was the culprit. We describe the various technical challenges faced during intervention, from cannulation to tracking of hardware. The RCA was cannulated using the floating wire technique and revascularised by the deployment of a 3.5 × 33 mm Xience Prime drug-eluting stent (Abbott Vascular, Santa Clara, CA, USA). In such a scenario where a conventional technique fails and where door-to-balloon time must be kept as short as possible, a little improvisation should resolve the problem.