Unnecessary PCI Attempt for Presumed CTO Which Was Revealed To Be Anomalous Coronary Arteries – Role of Coronary CT Angiography
DOI:
https://doi.org/10.1532/hsf.3143Keywords:
chronic total occlusion, coronary computed tomography angiography, anomalous coronary arteryAbstract
Herein, we present a brief case of anomalous coronary arteries mistaken to be chronic total occlusion. Since we first presumed the anomalous coronary arteries to be chronic total occlusion of the distal right coronary artery, percutaneous coronary intervention was attempted for the presumed lesion, but it failed. Before the second attempt of percutaneous coronary intervention, coronary computed tomography angiography revealed the coronary artery from the left anterior descending artery corresponding with the distal part of the right coronary artery without connection to the right coronary artery. Therefore, we recognized the patient had anomalous coronary arteries with no connection of the vascular wall between the main and distal segments of the right coronary artery.
This case may give insights to the importance of meticulous examination of coronary computed tomography angiography imaging before chronic total occlusion percutaneous coronary intervention to avoid the unnecessary procedure.
References
Aydinlar A, Cicek D, Senturk T, et al. 2005. Primary congenital anomalies of the coronary arteries: a coronary arteriographic study in Western Turkey. International heart journal. 46(1):97-103.
Brilakis ES, Banerjee S, Karmpaliotis D, et al. 2015. Procedural outcomes of chronic total occlusion percutaneous coronary intervention: a report from the NCDR (National Cardiovascular Data Registry). JACC Cardiovasc Interv. 8(2):245-253.
Brilakis ES, Mashayekhi K, Tsuchikane E, et al. 2019. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation. 140(5):420-433.
Cheng Z, Wang X, Duan Y, et al. 2010. Detection of coronary artery anomalies by dual-source CT coronary angiography. Clinical radiology. 65(10):815-822.
Choi JH, Chang SA, Choi JO, et al. 2013. Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries. Circulation. 127(6):703-709.
Choi JH, Kim EK, Kim SM, et al. 2015. Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography. JACC Cardiovasc Interv. 8(9):1143-1153.
Choi JH, Song YB, Hahn JY, et al. 2011. Three-dimensional quantitative volumetry of chronic total occlusion plaque using coronary multidetector computed tomography. Circ J. 75(2):366-375.
Hannan EL, Zhong Y, Jacobs AK, et al. 2016. Patients With Chronic Total Occlusions Undergoing Percutaneous Coronary Interventions: Characteristics, Success, and Outcomes. Circ Cardiovasc Interv. 9(5):e003586.
Perez-Pomares JM, de la Pompa JL, Franco D, et al. 2016. Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology--a position statement of the development, anatomy, and pathology ESC Working Group. Cardiovasc Res. 109(2):204-216.
Rathore S, Matsuo H, Terashima M, et al. 2009. Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries 2002 to 2008: impact of novel guidewire techniques. JACC Cardiovasc Interv. 2(6):489-497.
Yildiz A, Okcun B, Peker T, Arslan C, Olcay A, Bulent Vatan M. 2010. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol. 33(12):E60-64.
Yu CW, Lee HJ, Suh J, et al. 2017. Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion: Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Imaging. 10(4).
