Successful Percutaneous Coronary Intervention to a Totally Occluded Anomalous RCA Originating from Left Sinus Using Ikari Catheter

Aim: The right coronary artery (RCA), originating from the left sinus of Valsalva (LSOV), is a rare congenital anomaly seen in less than 3% of the total congenital coronary anomalies. They are usually asymptomatic, and some may present with symptoms due to ischemia, arrythmias, or sudden cardiac death. This report is made to illuminate the utility of the Ikari left guiding catheter for use with anomalous RCA from the left sinus of Valsalva.

Case Presentation: A sixty-year-old female presented with an inferior wall myocardial infarction. Coronary angiogram through the right radial approach using a 5F tiger catheter revealed a normal left system with tortuosities in LAD. After many unsuccessful attempts with the tiger catheter, RCA was engaged with 3.0 JR and found to be arising from the left aortic sinus with the mid RCA cut off. We used a 3.0 IKARI left guiding catheter for engaging the RCA through the femoral route, and successful percutaneous coronary intervention was done on the first attempt using a single guiding catheter.

Discussion: The RCA arising adjacent to the ostium of the left main coronary artery is the most common and is a technical challenge to engage. A good selection of guiding catheters is important for a successful percutaneous coronary intervention (PCI). We have used the Ikari left guiding catheter (ILGC) in this case, which is a universal catheter suitable for both left and right coronary arteries.

Conclusion: There is no universal ideal guiding catheter for the engagement of all abnormal RCA origin cases. Ikari can usually be considered a preferred catheter for PCI to RCA arising from the left sinus (Type A) and is generally safe too.