PMC6083481_01
Diagnostic angiogram: left anterior oblique/cranial view demonstrating the LAD and diagonal branches.
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It gives off a large diagonal branch with mild diffuse disease (Figure 1).
(a) Diagnostic angiogram in left anterior oblique/caudal view; (b) right anterior oblique/caudal view demonstrating the LAD ramus branch with moderate disease and diminutive circumflex branches (arrow).
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Right coronary artery with collaterals to the circumflex artery.
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The A-V circumflex turns at an acute angle away from the left main artery (Figure 3) (video file 1).
Dual angiogram demonstrating the different plane of origin of the circumflex artery.
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Dual angiogram demonstrating the course of the circumflex artery in a plane different from the left main artery:guide catheters in the right coronary artery and left main coronary artery in left anterior oblique/caudal view.
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Dual angiogram with guide catheters in the right coronary artery and the anomalous origin of the circumflex artery.
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The patient did not have CTO of the circumflex but instead had severe stenosis of his anomalous circumflex (Figure 6).
Final angiographic result after PCI of the anomalous circumflex artery.
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