CORONARY - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
The Finecross of the Day - A Case of Percutaneous Intervention to Anomalous Right Coronary Artery
Khairul Shafiq Ibrahim1, Abdul Wahab Undok2, Rizmy Najme Khir3, Raja Ezman Raja Shariff3, Sazzli Kasim3
UiTM Medical Specialist Centre, Malaysia1, KPJ Rawang Specialist Hospital, Malaysia2, Universiti Teknologi MARA, Malaysia3,
Mr AB is a 78 years old man with type 2 diabetes and dyslipidaemia. He actively cycles 80km per week and regularly does a 10km run. He presented with a one-month history of progressively reduced effort tolerance and chest pain on exertion. On examination, he is generally well with normal vital signs. Cardiovascular and respiratory examinations were unremarkable.
His haemoglobin was 14.4 g/dL, low density lipoprotein of 4.0 mmol/L, eGFR of 64ml/min/1.73m2
and HbA1C of 6.9%. His electrocardiogram showed left ventricular hypertrophy with diffuse ST segment depression and AVR ST elevetion. Echocardiogram showed left ventricular ejection fraction of 48% with hypokinetic over mid to apical posterior, anterior, lateral and septal.
In an anomalous right coronary artery arisen from left coronary cusp intervention, Judkins left 4.0 guiding catheter via right radial artery approach can be used. Adjunct use of microcatheter can be attempted to provide support for catheter engagement into coronary artery.