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Coronary angiography showing split left coronary arteries (case no.1). (A) Separately engaged LCx (arrow). (B) Separately engaged LAD (arrow). (C) Separate ostia for LAD and LCx (arrows). (D) Culprit lesion in mid-LAD (arrows).
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During the effort to engage the left coronary system in the left anterior oblique caudal (LAO-caudal) projection it was possible to visualize only the left circumflex artery (LCx) but not the left anterior descending artery (LAD) (Fig. 1A). In the same projection, by gently pulling the catheter back and testing injections of contrast, we were able to identify separate origin of LAD (Figs. 1B and C). In the right anterior oblique cranial (RAO-cranial) projection a separate origin of LAD and LCx was demonstrated, and culprit lesion in mid-LAD (subocclusion) was identified (Fig. 1D).
Primary percutaneous coronary intervention in LAD (case no.1). (A) Stent deployment. (B) The final angiographic result.
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Subsequently, LAD was engaged and percutaneous intervention was performed with a drug-eluting stent achieving TIMI flow grade 3 (Figs. 2A and B).
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Coronary angiography showing absence of left main coronary artery (case no. 2). (A and B) LAD and LCx arising from separate ostia in the left coronary sinus (arrows). (C) Separately engaged LAD detecting culprit lesion (arrow). (D) Separately engaged LCx (arrow).
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The left main coronary artery was split into the left anterior descending artery (LAD) and the left circumflex artery (LCx) (Figs. 3A and B). Since there was no common left main coronary artery, LAD was separately engaged in posterior anterior cranial (PA-cranial) projection and LCx in left anterior oblique cranial (LAO-cranial) projection, confirming the culprit lesion (occlusion) in distal LAD (Figs. 3C and D).
Primary percutaneous coronary intervention in LAD (case no 2). (A) The stent balloon is inflated, deploying the stent. (B) The final angiographic result.
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Finally, it performed PCI in the LAD with a drug-eluting stent which resulted in TIMI flow grade 3 (Figs. 4A and B).