Emergency Percutaneous Coronary Intervention in the Setting of a Single Left Coronary Ostium

A 34-year-old man with no significant cardiac risk factors presented with an anterolateral ST-elevation myocardial infarction and was transferred to our institution for rescue percutaneous coronary intervention after failed thrombolysis. At the time of the procedure, he had ongoing chest pain, and there was persistent ST-segment elevation on the ECG. The right coronary artery (RCA) could not be located with a series of diagnostic catheters. Diagnostic images of the left coronary artery showed the circumflex artery and an aberrant dominant RCA arising from the left main stem but, despite multiple views, the left anterior descending artery could not initially be identified (Figure 1; Videos 1 and 2). An aortogram demonstrated only a single coronary ostium in the left coronary sinus. After re-engaging the left coronary artery for further diagnostic images, the left anterior descending artery was finally identified, which was occluded at its ostium and visible in one view only (Figure 2; video 3). After guide wire passage, flow was restored in the culprit vessel and subsequent intervention was uncomplicated with a single 3-mm bare metal stent deployed (Figure 3; Videos 4 through 6). There was TIMI 3 flow at the end of …