# Quadriostial Origin of the Coronary Arteries: A Case Report

## TL;DR

A 75-year-old man was found to have four separate coronary artery openings, a rare anatomical variation, but remained asymptomatic.

## Contribution

This case report presents a rare quadriostial coronary artery origin and discusses its clinical implications.

## Key findings

- The patient had four coronary artery ostia instead of the usual two.
- The right coronary cusp had two ostia, one for the RCA and one for the LAD.
- The left coronary cusp also had two ostia, one for the LCX and one for the marginal artery.

## Abstract

A 75-year-old male, with a history of hypertension and peripheral vascular disease, presented to the cardiac catheterization lab for an elective coronary angiogram after an abnormal cardiac stress test. The coronary angiogram results showed a total of four separate coronary artery ostia. Within the right coronary cusp, there were two separate ostia as opposed to a single ostia that supplies the right coronary artery (RCA). The additional ostia gave rise to the left anterior descending artery (LAD). Further, as opposed to the single ostia in the left coronary cusp, there were two separate ostia creating a left circumflex (LCX) and marginal artery. Despite this anomalous anatomy, the patient was asymptomatic and instructed to continue to follow up with outpatient cardiology. Our case report discusses this unique quadriostial coronary anatomy, the complications that can arise from anomalous coronary arteries, diagnoses, and management of such cases.