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Intravascular Ultrasound guided Percutaneous Coronary Intervention for the Ostial Lesion of the Anomalous Left Circumflex Artery Originated from Left Coronary Cusp Directly

Toshiki Kuno, Kenji Hashimoto and Yohei Numasawa

Percutaneous coronary intervention (PCI) for the ostial lesion of the anomalous left circumflex artery (LCX) originating from the left coronary cusp is challenging because of the difficulty in correctly determining the position of the ostium. This report examines the case of an 81-year-old man with a non-ST segment elevation myocardial infarction with an anomalous LCX origin. An angiography showed the diffuse plaque including the ostium. After successfully engaging an Amplatz-Left guiding catheter and observing the lesion with intravascular ultrasound (IVUS), we dilated the vessel with a balloon. Since we needed to implant the stent to cover the ostial lesion, we used IVUS in combination with angiography to correctly determine the position of the ostium. The stent was implanted successfully and, to our knowledge, this is the first case report of PCI for the separated ostium of the anomalous LCX originating from the left coronary cusp, including the ostial lesion. We also present the IVUS images of both the left anterior descending artery and the LCX.