Primary Angioplasty for STEMI Patients With Anomalous Left Coronary Artery Arising From Right Coronary Sinus.

BACKGROUND

Anomalous origin of the left main coronary artery from the right sinus of Valsalva (ALCA-RSV) is exceedingly rare yet complicates emergency angioplasty for ST-segment elevation myocardial infarction.

CASES SUMMARY

We describe 2 ST-segment elevation myocardial infarction patients in whom ALCA-RSV was identified during primary percutaneous coronary intervention. Despite procedural challenges, timely revascularization was achieved using customized access, catheter strategies, and adjunctive devices. Postprocedural computed tomography coronary angiography excluded malignant courses. Both patients achieved positive outcomes.

DISCUSSION

ALCA-RSV, while exceptionally uncommon, is associated with sudden cardiac death and procedural difficulties during percutaneous coronary intervention. Early identification, precise anatomical imaging, and adaptable techniques are key to successful management. This series contributes to limited existing literature, underscoring that favorable results are possible with tailored intervention strategies.

TAKE-HOME MESSAGES: ALCA-RSV complicates emergency angioplasty and necessitates adjusted strategies to achieve revascularization. Multimodality imaging aids risk assessment and delineates malignant from benign courses.