Primary Percutaneous Coronary Intervention in a Case of Dual Right Coronary Artery Presenting As Acute Coronary Syndrome

Anish Hirachan

doi:10.31579/2641-0419/183

Abstract

Dual right coronary artery (RCA) is a rare coronary anomaly. This anomaly is often undetected and may be totally asymptomatic to presenting as acute coronary syndrome. Here, we present a 41 year old male diabetic and smoker presented with acute onset severe chest pain of 30 minutes duration which was managed as acute coronary syndrome .His urgent coronary angiogram revealed single ostial origin of right coronary artery ( RCA) with total occlusion from proximal segment followed by double right coronary arteries with their respective distal branches.

Highlights

Coronary arterial anomalies (CAAs) can be presented as a wide range of abnormalities of coronary anatomy, ranging from those that are benign morphologic variants and do not have any clinical implications to those that have an established association with sudden cardiac death (SCD) and present as acute coronary syndrome
Double right coronary artery (RCA) though being a relatively rare entity, it is not necessarily benign, as it has been associated with atherosclerosis, life-threatening arrhythmia and even myocardial infarction. [4,5,6] In the absence of atherosclerotic stenosis, ischemia can be a result of anatomical malformations, including an acute takeoff angle
Some authors have claimed that it is very difficult to distinguish double RCA with single orifice, from RCA which has a high take- that off of a large right ventricular artery, solely by coronary angiography. They have mentioned that right anterior oblique (RAO) view provides better demonstration of artery courses and may be helpful in differentiating double RCA from a large right ventricular branch

Summary

Introduction

Coronary arterial anomalies (CAAs) can be presented as a wide range of abnormalities of coronary anatomy, ranging from those that are benign morphologic variants and do not have any clinical implications to those that have an established association with sudden cardiac death (SCD) and present as acute coronary syndrome. [1] Among them, double right coronary anomaly is even very rare and have been reported in few case reports in literature. His Left coronary angiogram revealed normal origin, flow and caliber in left anterior descending artery (LAD) and left circumflex artery (LCX).

Results

Conclusion