Percutaneous coronary intervention for ostial lesions of the left main stem in a patient with congenital single left coronary artery: A case report

BACKGROUND Single coronary artery (SCA) originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery. Furthermore, a right coronary artery (RCA) arising from the mid segment of the left anterior descending artery (LAD) is an extremely uncommon variation of SCA. CASE SUMMARY A 76-year-old woman presented a 5-mo history of exertional angina. Selective coronary angiography revealed an SCA, with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery. In addition, an anomalous RCA originated from the mid segment of the LAD as a separate branch. Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient. CONCLUSION Percutaneous coronary intervention (PCI) of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery. Although technical difficulties and risks do exist, PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.