CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
e1
Case Report
Multi-slice computed tomography assessment of stent
position in a patient with acute coronary syndrome and
anomalous origin of the coronary arteries
PLINIO CIRILLO, GIANLUCA PETRILLO, RAFFAELE PICCOLO, GIANCARLO MESSALLI, FRANCESCA
ZIVIELLO, MICHELE BEVILACQUA, MARCO SALVATORE, FEDERICO PISCIONE, BRUNO TRIMARCO
Abstract
We describe the case of a woman with acute coronary
syndrome who was treated by percutaneous coronary inter-
vention (PCI) and stenting of the proximal right coronary
artery, which shared its short origin with the left anterior
descending artery. A multi-slice computed tomography study
of the patient’s coronary tree, performed after percutaneous
treatment, played a fundamental role in obtaining a clearer
view of the coronary anatomy, as well as of stent positioning
in this particular anatomy, eliminating any doubt about the
PCI result.
Keywords:
acute coronary syndromes, coronary artery anoma-
lies, percutaneous coronary intervention, multi-slice computed
tomography
Submitted 11/3/12, accepted 13/3/13
Cardiovasc
J Afr
2013;
24
: e1–e3
DOI: 10.5830/CVJA-2013-012
Coronary arteries with an anomalous origin from the aorta or an
anomalous course may present a problem for the interventional
cardiologist. Percutaneous coronary intervention (PCI) of these
arteries may be very complicated. Specifically, when the origin
of these aberrant coronary arteries is positioned along the
ascending aorta, it is not easy to access them.
1
Moreover, the
presence of an anomalous course does not help the interventional
cardiologist to choose the appropriate strategy to treat the
atherosclerotic lesion.
In the present report we describe the case of a patient admitted
to our hospital for an acute coronary syndrome (ACS) who was
treated with primary PCI with stent implantation at the origin
of the right coronary artery (RCA). Unfortunately, the RCA
shared a common origin with the left anterior descendent artery
(LAD). A multi-slice computed tomography (MSCT) study of
the patient’s coronary tree played a fundamental role in obtaining
a clearer view of the coronary anatomy and the stent position,
considering this particular anatomy.
Case report
A 58-year-old-woman was admitted to the emergency room with
chest pain and vomiting. On admission, an electrocardiogram
(ECG) showed bradycardia with slight ST elevation in the
inferior leads (DIII and aVF). Serum levels of the markers of
myocardial damage were increased. The patient was sent to the
catheter laboratory to undergo coronary angiography.
The angiography showed that the circumflex artery (LCx)
originated from the left sinus of Valsalva, and the RCA and LAD
might have a common origin from the right sinus of Valsalva
(Fig. 1A–C). Moreover, the proximal segment of the RCA
had severe stenosis with evidence of thrombus, causing a slow
run-off in the distal vessel (Fig. 1C).
Unfortunately, the coronary angiography did not allow us to
firmly establish whether the LAD and RCA had a very short
common origin or emerged separately. However, since the
patient’s clinical conditions had worsened and ECG changes
were observed, we decided to perform a PCI on the culprit lesion.
The anomalous coronary artery was cannulated with a 6-Fr
JR 4.0 guiding catheter and a 0.014-inch hi-torque balance
heavyweight guidewire was used (Abbott Vascular, Santa Clara,
CA, USA). Two paclitaxel-eluting stents (Taxus Element 4.0
×
8
mm and Taxus Element 3.5
×
12 mm; Boston Scientific, Natick,
MA, USA) were successfully implanted.
Control angiography showed a good angiographic result with
perfect visualisation of the RCA and LAD (Fig. 1D). However,
it was still unclear whether the RCA and LAD had a common
origin or not, and whether the stents were implanted without
involving the origin of the LAD.
A few days later, the patient underwent MSCT. Tomography
showed that the LAD and RCA had a very short common origin
and that the LAD’s course was inter-arterial (Fig. 2). Moreover,
MSCT indicated that the stents were adequately implanted and
that they did not cause obstruction of the LAD origin.
Division of Cardiology, Department of Advanced Biomedical
Sciences, University of Naples, Naples, Italy
PLINIO CIRILLO, MD, PhD,
GIANLUCA PETRILLO, MD
RAFFAELE PICCOLO, MD
FRANCESCA ZIVIELLO, MD
MICHELE BEVILACQUA, BSc
FEDERICO PISCIONE, MD
BRUNO TRIMARCO, MD
Division of Radiology, Department of Advanced Biomedical
Sciences, University of Naples, Naples, Italy
GIANCARLO MESSALLI, MD
MARCO SALVATORE, MD
