CHALLENGES OF ANOMALOUS CORONARY ARTERY INTERVENTIONS – A CASE SERIES

Abstract

Background: The Dual left anterior descending (LAD) artery is a rarely reported coronary anomaly, consisting of
two branches supplying the usual distribution of the LAD. Type 4 and type 10 dual LAD anomalies in which a
short LAD arises from the left main coronary artery and a long LAD arise from the right coronary artery or right
coronary artery sinus respectively are remarkably rare. The s-LAD (Short LAD) should not be misdiagnosed as
total occlusion of distal segment and the l-LAD (Long LAD) arising from proximal RCA or right coronary sinus,
should not be misidentified as a conus branch. Recognition of the dual LAD is of critical importance before
planning any revascularization procedures, and all novice cardiologists should be aware of this rare congenital
coronary anomaly.
Case Presentation: We describe a total of four cases of dual LAD coronary anomalies consisting of two cases
each of type 4 and type 10 anomalies, which are rarely encountered in clinical practice detected by
conventional coronary angiogram (CAG) and subsequently underwent successful Percutaneous Coronary
Intervention (PCI) of each anomaly, highlighting the importance of knowledge of these rare anatomical
variants and application of this knowledge in clinical practice contributing to the success of interventional
procedure translating into improved patient outcomes.
Conclusion: This case series demonstrates the importance of knowledge regarding the presence of rare
variants of dual LAD coronary anomalies which aid in the diagnosis and management of these patients
ensuring successful revascularisation, with either PCI or CABG, translating into symptomatic relief and
significant cardiovascular benefit.