The patient was discharged from the hospital one day after the stenting procedure and remained asymptomatic one year later.Ī 71-year-old woman presented with syncope and complete atrioventricular block associated with acute inferior myocardial infarction (MI) of one hour's duration.
Finally, 2 overlapping stents were deployed at the proximal and mid RCA with good angiographic results ( Fig. A GuideLiner catheter was deployed to selectively catheterize the artery. A Judkins 3.5 left guide catheter was inserted through the right radial artery and advanced until it engaged the RCA. Given the low risk of this subtype of R-ACAOS with a course below the pulmonary artery and aorta compression plane, we decided to perform PCI.
The stress MRI scan showed ischemia of the inferior wall, and the cardiac CT angiogram revealed R-ACAOS with a low interarterial course below the valve plane and severe stenosis at the mid RCA. Two weeks before presentation, the patient had undergone stress magnetic resonance imaging (MRI) and multislice cardiac computed tomographic (CT) angiography. The patient was discharged from the hospital 3 days later with normal systolic left ventricular function, and she remained asymptomatic 1.5 years later.Ī 68-year-old man with one kidney and effort angina presented for coronary angiography. Finally, 2 overlapping drug-eluting stents were deployed at the mid and proximal RCA, resulting in Thrombolysis In Myocardial Infarction (TIMI)-3 flow and relief of chest pain ( Fig. An aspiration catheter was then advanced through the occluded segment with use of a GuideLiner catheter to provide backup support and selectively catheterize the vessel. An Amplatz left 1.0 guide catheter was inserted and advanced to engage the RCA ostium, followed by a Balance Middleweight wire however, distal flow was not restored. A subsequent aortogram revealed complete occlusion of an anomalous RCA originating from the left coronary sinus (R-ACAOS). An urgent coronary angiogram obtained through the right radial artery revealed a regular left coronary artery tree however, the right coronary artery (RCA) could not be located despite the use of several different catheters (Judkins right 4.0, Amplatz right 2.0, and Judkins left 3.5). An electrocardiogram obtained at presentation showed ST-segment elevation in the inferior leads. A 52-year-old-woman with no known cardiovascular risk factors presented with acute chest pain of one hour's duration.
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