Intravascular Ultrasound guided Percutaneous Coronary Intervention for the Ostial Lesion of the Anomalous Left Circumflex Artery Originated from Left Coronary Cusp Directly

Toshiki Kuno,Kenji Hashimoto

doi:10.4172/2329-9495.1000176

Abstract

Percutaneous coronary intervention (PCI) for the ostial lesion of the anomalous left circumflex artery (LCX) originating from the left coronary cusp is challenging because of the difficulty in correctly determining the position of the ostium. This report examines the case of an 81-year-old man with a non-ST segment elevation myocardial infarction with an anomalous LCX origin. An angiography showed the diffuse plaque including the ostium. After successfully engaging an Amplatz-Left guiding catheter and observing the lesion with intravascular ultrasound (IVUS), we dilated the vessel with a balloon. Since we needed to implant the stent to cover the ostial lesion, we used IVUS in combination with angiography to correctly determine the position of the ostium. The stent was implanted successfully and, to our knowledge, this is the first case report of PCI for the separated ostium of the anomalous LCX originating from the left coronary cusp, including the ostial lesion. We also present the IVUS images of both the left anterior descending artery and the LCX.

Highlights

A separate origin of the left anterior descending (LAD) and left circumflex artery (LCX) from the left coronary cusp (LCC) is a rare congenital anomaly and is found in 0.29%-0.69% of coronary angiography or computed tomography cases [1,2,3,4]
We report a case of non-ST elevation myocardial infarction with an ostial lesion of the anomalous LCX origin, in which the patient underwent successful Percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS)
We recommend using IVUS to implant the stent for ostial lesions of the LCX originated from the LCC

Summary

Introduction

A separate origin of the left anterior descending (LAD) and left circumflex artery (LCX) from the left coronary cusp (LCC) is a rare congenital anomaly and is found in 0.29%-0.69% of coronary angiography or computed tomography cases [1,2,3,4]. Reports of percutaneous coronary intervention (PCI) for an anomalous LCX originating from the LCC are scarce. Performing PCI for an ostial lesion of an anomalous LCX from the LCC is challenging because of the difficulty in correctly determining the position of the ostium. We report a case of non-ST elevation myocardial infarction with an ostial lesion of the anomalous LCX origin, in which the patient underwent successful PCI with intravascular ultrasound (IVUS)

A Case Report

Discussion

Conclusion