Myocardial infarction in a patient with single coronary artery - rare but real.

A 53-year-old woman was referred to our hospital with acute coronary syndrome. The coronary angiography demonstrated a single coronary artery. Culprit lesion was a subtotal occlusion of the proximal left anterior descending coronary artery, which was recanalized and treated with drug-coated balloon angioplasty. The patient recovered quickly after the procedure. A coronary computed tomography angiography visualized the left main coronary artery, which was passing between the ascending aorta and the pulmonary trunk and categorized this anomaly as R-II-B according to Lipton's classification, representing an extremely rare coronary anomaly. < ST-segment elevation myocardial infarction can present with atypical electrocardiographic manifestations. Percutaneous coronary intervention with drug-coated balloon may be considered in patients with relevant coronary stenosis in an anomalous coronary artery.>.