Akut Koroner Sendrom ile Başvuran Hastada Tek Koroner Arter Anomalisi
Özet
Nadir görülen (%0.016-0.066) tek koroner arter anomalisi saptanan ve ST yükselmesiz miyokart enfarktüsü (NSTEMI) ile başvuran 60 yaşında bir erkek hastada, standart kateterizasyonla sol ana koroner ostium kanüle edilememiştir. Yapılan anjiyografide sol ön inen arter (LAD) ve sirkumfleks arterin (CX), sağ koroner arterden (RCA) ayrı ostiumlarla çıktığı saptanmıştır. RCA proksimal ve distal bölgelerindeki ciddi darlıklara başarıyla stent implantasyonu gerçekleştirilmiştir. İleri inceleme amacıyla çekilen koroner bilgisayarlı tomografi anjiyografide (BTA), CX arterinin aort ve pulmoner damarlar arasından seyrettiği doğrulanarak hastaya R-III tipi tek koroner arter anomalisi tanısı konulmuştur. Genellikle asemptomatik veya benign kabul edilen bu anomali türü, tüm koroner akımın tek bir ostiumdan sağlanması nedeniyle girişimsel müdahale süreçlerini daha riskli ve katastrofik komplikasyonlara açık hale getirmektedir. Olgu, benzer anomalilere sahip hastalarda endikasyon varlığında perkutan koroner girişimlerin titizlikle uygulanabileceğini göstermektedir.
A 60-year-old male patient presented with non-ST-elevation myocardial infarction (NSTEMI) and was diagnosed with a rare single coronary artery anomaly occurring at a rate of 0.016-0.066%. During coronary angiography, the left main coronary ostium could not be cannulated using standard catheters, subsequently revealing that the left anterior descending (LAD) and circumflex (CX) arteries originated from separate ostiums within the right coronary artery (RCA). Significant stenoses were detected in the proximal and distal segments of the RCA, and stent implantation was successfully performed on these lesions. Elective coronary computed tomography angiography (CTA) confirmed that the CX artery coursed between the aorta and pulmonary vessels, establishing a definitive diagnosis of type R-III single coronary artery anomaly. Although usually asymptomatic or benign, this anomaly increases the risk of interventional procedures and potential catastrophic complications due to the entire blood supply relying on a single ostium. This case highlights the feasibility and necessity of percutaneous coronary interventions in such anomalous variations when indicated.
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