Article Text

Download PDFPDF
Unprotected single coronary artery main-stem angioplasty
  1. Niket Patel,
  2. Nikant Sabharwal,
  3. Adrian P Banning
  1. Department of Cardiology, Oxford University Hospitals, UK
  1. Correspondence to Dr Niket Patel, Department of Cardiology, Oxford University Hospitals, UK; niket.patel{at}ndm.ox.ac.uk

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

An 84-year-old female presented with exertional angina. Coronary angiography demonstrated an anomalous coronary artery with a single ostium arising from the right coronary sinus with a calcified stenosis of the ‘common right main-stem’ (CRMS), and only mild plaque disease distally in the left coronary artery (LCA) (figure 1A). CT coronary angiography confirmed the anatomy (figure 1B), and the heart team discussion recommended intervention.

Figure 1

Preintervention imaging. (A) Coronary angiogram showing an anomalous solitary ostium of a single coronary artery from the right coronary sinus with a calcified stenosis (arrow) of the ‘common right main-stem’ (CRMS)). (B) CT angiogram confirming a single origin with calcific disease. (C) Intravascular ultrasound stills of a pullback from the right coronary artery (RCA) into the (CRMS) prior to percutaneous coronary intervention. Access the article online to view this figure in colour.

Intravascular ultrasound (IVUS) interrogation of both major branches revealed calcified disease of the CRMS ostium and further significant disease of the right coronary artery (RCA) distal to the primary bifurcation (figure 1C). Fractional flow reserve (FFR) in the RCA was 0.55 and 0.80 in LCA. Therefore, a provisional one-stent strategy with a single 4×15 mm drug eluting stent from CRMS to RCA was performed and postdilated with a 4 mm non-complaint balloon and final 4 mm/3.5 mm kissing balloon inflations (figure 2A). The postintervention IVUS revealed good stent apposition with no compromise of the LCA ostium (figure 2B). Furthermore, postprocedure FFR was 0.90 in the RCA and 0.82 in the LCA.

Figure 2

Postintervention results. (A) The final appearance following intervention to the common right main-stem (CRMS) with a 4×15 mm drug eluding stent. (B) Shows intravascular ultrasound stills of a pullback from the left coronary artery (LCA). The left-hand still demonstrates a well-deployed stent in the CRMS. The right-hand still is of the CRMS bifurcation showing non-significant compromise of the LCA ostium.

The incidence of anomalous coronary anatomy is approximately 1%1 and 0.02% of a common single coronary artery with a right coronary cusp origin.2 Intervention to the common origin of a single coronary artery has not been reported previously to our knowledge. We suggest that intervention to the CRMS bifurcation should be both functionally and anatomically guided to avoid unnecessarily complex stenting. The final result should be assessed poststenting to confirm procedural success.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Footnotes

  • Contributors AB/NP planned the article. NP prepared the manuscript. NP/NS prepared the images/figures. AB revised submission to final version and acts as guarantor responsible for the overall content of the submission.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.