What is the clinical evidence from this study?

Study design: Case Report. Population: Acute coronary syndrome and coronary artery anomaly (n=1). Intervention: Percutaneous coronary intervention and CCTA. Primary outcome: Major adverse cardiac events.

What does this research mean for the field?

Percutaneous coronary intervention guided by coronary computed tomography angiography (CCTA) can successfully revascularize a rare anomalous left anterior descending artery originating from the right coronary cusp. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 8, 2026Open Access

Coronary Artery Anomalies Presenting with Acute Coronary Syndrome and Challenges Faced in Percutaneous Coronary Intervention: A Rare Case Report

Key Result

Percutaneous coronary intervention guided by CCTA successfully revascularized a rare anomalous LAD originating from the right coronary cusp, with the patient remaining free of MACE at 6 months.

Key Points

This report aims to describe a rare case of coronary artery anomalies presenting with acute coronary syndrome and the challenges faced during intervention.
Case report of a 61-year-old male with acute coronary syndrome and Type A Wellens syndrome.
Coronary angiography and computed tomography angiography were performed to define the coronary anatomy.
Percutaneous coronary intervention was carried out via a right transfemoral approach using a Judkins Right 7F catheter.
Successful revascularization of the left anterior descending artery lesion was achieved.
The patient remained free of major adverse cardiac events at 6-month follow-up.
The case illustrates the procedural challenges of coronary anomalies during interventions.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

61-year-old male presenting with acute coronary syndrome (ACS) and Type A Wellens syndrome, with an extremely rare anomaly where all three coronary arteries originated from the right coronary cusp with separate ostia.

Intervention

Percutaneous coronary intervention (PCI) via a right transfemoral approach using a Judkins Right 7F catheter, guided by coronary computed tomography angiography (CCTA).

Outcome

Successful revascularization of the culprit LAD lesion and freedom from major adverse cardiac events (MACE).

This case highlights the procedural challenges of PCI in patients with rare coronary anomalies and the utility of CCTA in defining the coronary course to guide safe intervention.

Abstract

Abstract Coronary artery anomalies are rare congenital conditions with a prevalence of <1% in the general population. We describe a 61-year-old male who presented with acute coronary syndrome (ACS) and Type A Wellens syndrome. Coronary angiography demonstrated an extremely rare anomaly in which all three coronary arteries originated from the right coronary cusp with separate ostia. Coronary computed tomography angiography (CCTA) further delineated a benign retroaortic course of the left anterior descending artery (LAD). Percutaneous coronary intervention was performed via a right transfemoral approach using a Judkins Right 7F catheter, achieving successful revascularization of the culprit LAD lesion. The patient recovered uneventfully and remained free of major adverse cardiac events at 6-month follow-up. This case underscores the procedural challenges posed by anomalous coronary anatomy and highlights the critical role of computed tomography imaging in defining the coronary course and guiding safe intervention. When an anomalous coronary origin is suspected during ACS evaluation, urgent CCTA may be useful to define the coronary course before revascularization in selected cases. The combination of all three coronary arteries arising from the right coronary cusp, along with a retroaortic LAD course, emphasizes the rarity and clinical relevance of this presentation.