# “Single Coronary Artery” from Right Sinus—Uncommon Causes of Ischemia with Non-Obstructive Coronary Arteries

## TL;DR

This paper discusses two cases of rare coronary artery anomalies that can cause ischemia despite non-obstructive arteries.

## Contribution

The study highlights the importance of angio-CT in diagnosing rare coronary anomalies and guiding treatment decisions.

## Key findings

- A 22-year-old male had an undeveloped left main coronary artery, supplied by the right coronary artery.
- A 77-year-old female also lacked a left main coronary artery, with the right coronary artery supplying the left coronary artery.
- Angio-CT proved valuable in identifying these anomalies and informing clinical management.

## Abstract

Anomalies of coronary artery origins are rare but significant conditions that can range from benign to life-threatening. Early detection through imaging is crucial in preventing adverse outcomes. The treatment strategy varies depending on the type and severity of the anomaly, ranging from pharmacological treatment to surgery. A 22-year-old male patient, after syncope, after excluding other causes, had an exercise drill test, which was clinically negative and ECG-positive. Angio-CT revealed an undeveloped left main coronary artery (LMCA), and the circulation was supplied through the right coronary artery (RCA). The RCA provides the left anterior descending artery (LAD), and the LAD retrogradely supplies the left circumflex artery (LCX). The myocardial perfusion scintigraphy showed a slight lack of perfusion in the anterior wall (6% of total perfusion). The patient was qualified for further observation. A 77-year-old female underwent cardiac CT due to stenocardia. CT showed a lack of LMCA. The initial segment of the RCA gave rise to the left coronary artery (LCA), which encircled the aortic bulb posteriorly and bifurcated into branches resembling the LCX and LAD. After the Heart Team consultation, the patient was deemed eligible for conservative treatment. Angio-CT is a valuable tool for detecting coronary artery anomalies.