# Navigating the Uncommon: PCI to an Anomalous Right Coronary Artery With a Malignant Course Following Failed Arterial Grafts

## TL;DR

A 67-year-old man with a rare heart artery anomaly and failed bypass surgery successfully underwent a complex heart procedure.

## Contribution

This case report highlights the challenges and techniques involved in PCI for an anomalous right coronary artery with a malignant course.

## Key findings

- CT coronary angiography was crucial for planning the PCI due to the anomalous anatomy.
- Successful PCI was achieved despite the challenges of engaging the anomalous right coronary artery.
- The case emphasizes the importance of advanced imaging and specialized techniques in managing complex coronary anomalies.

## Abstract

A 67-year-old male presented with non-ST elevation myocardial infarction (NSTEMI) with underlying anomalous origin of the right coronary artery (RCA) and a malignant course between the aorta and pulmonary artery. Previous CABG with LIMA and RIMA grafts had failed, leaving the patient with severe in-stent restenosis (ISR) in the LAD and degenerated, blocked grafts. The patient underwent percutaneous coronary intervention (PCI) to the anomalous RCA, which posed challenges in engagement due to its anomalous course. This case report discusses the complexities of managing such anatomies, emphasizing the role of CT coronary angiography, the difficulty of engaging anomalous arteries, and the techniques used to achieve successful PCI.