Percutaneous coronary intervention in anomalous aortic origin of a coronary artery: a rare case report of a dual-left anterior descending artery with a pre-pulmonary course

Anomalous aortic origin of a coronary artery (AAOCA) of the left anterior descending artery (LAD) is a rare congenital anomaly. Their percutaneous coronary intervention (PCI) when an ischaemia is documented remains challenging.

We report the case of a 52-year-old patient from Bangladesh with dual-origin LAD arising from both left and right sinus with a pre-pulmonary course, presenting with exertional angina and documented myocardial ischaemia. Computed tomography (CT) scan confirmed the anatomical course of the AAOCA. Percutaneous coronary intervention was successfully performed using tailored techniques to treat significant atherosclerotic lesions.

This case underscores the importance of CT scan in delineating the anatomical characteristics of AAOCA, and the feasibility and efficacy of PCI in symptomatic, non-high-risk AAOCA, emphasizing its role as a minimally invasive alternative within a multidisciplinary approach.