PMC5143685_01
Electrocardiogram before (a) and after (b) the PCI.
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The patient was discharged without electrocardiogram changes (Figure 1(b)) and was asymptomatic at the 2-year follow-up point.
(a) CT (3D view) showing stenosis of the mid-LAD artery (indicated by the red arrow). (b) Multiplanar reconstruction view of the LAD artery (CT). The red arrow shows stenosis of the mid-LAD artery. (c) Red arrow showing arising ostium of the LCA (sectional view, CT). (d) Red arrow showing arising ostium of the LCA (3D view, CT).
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The CT showed a diffuse plaque in the middle of the left anterior descending (LAD) artery (Figures 2(a) and 2(b), red arrows) and an anomalous LCA originating from the NCC (Figures 2(c) and 2(d), red arrows). The patient was then admitted for a coronary angiography under suspicion of unstable angina.
(a) Diagnostic coronary angiogram of the LCA (LAO/caudal view). (b) Diagnostic coronary angiogram of the LCA (LAO/cranial view). The arrow shows stenosis of the mid-LAD artery. (c) Cusp contrast injection with Amplatz-Left (LAO view). The arrow shows the ostium of the LCA. (d) Coronary angiogram with Judkins-Right guiding catheter with 2 wires.
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Since we could not engage the 6-F Judkins-Left 3.5 Goodtec  (Goodman, Gifu, Japan) catheter smoothly because of the anomalous origin, we straightened it to engage it (Figure 3(a), Online Video 1 in Supplementary Material available online at http://dx.doi.org/10.1155/2016/2097174). After the catheter was engaged, the coronary angiogram showed 90% stenosis in the middle of the LAD artery (Figure 3(b), red arrow, Online Video 2). However, we were unable to engage it (Figure 3(c), Online Video 3). We then inserted the guiding catheter deeply and inserted Balance into the distal portion of the LAD artery (Figure 3(d), Online Video 4).
(a) Final coronary angiogram after stenting (red arrow). (b) Diagnostic coronary angiogram after 2 years of stenting.
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The patient's final coronary angiogram revealed successful stenting in the mid-LAD artery (Figure 4(a), Online Video 5). The angiogram performed with an Amplatz-Left 1.0 diagnostic catheter showed the patent stent and no new lesions (Figure 4(b)).