Rotational atherectomy and simultaneous kissing stenting of a bifurcation stenosis of left anterior descending and anomalous right coronary arteries.

Intervention to anomalous coronaries can present specific challenges: non-standard guide catheters may be required to provide adequate access and support, the course of the arteries can be tortuous with sharp angulations, and they may subtend a critical area of myocardium. We present the first report of percutaneous coronary intervention to the bifurcation of an anomalous right coronary artery arising from the left anterior descending artery. This lesion contained a high burden of calcification, which required rotational atherectomy of the left anterior descending artery before kissing stenting of the bifurcation.