This report describes an 18-year longitudinal clinical course of a patient with a rare single coronary ostium originating from the right coronary sinus. The patient underwent percutaneous coronary intervention (PCI) with bare-metal stents (BMS) to the proximal left anterior descending artery (LAD) and proximal right coronary artery (RCA) in 2007, with complete long-term patency and no restenosis for nearly two decades. In August 2025, he presented with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) caused by a new, heavily calcified 99% mid-LAD stenosis. PCI required high-pressure plaque modification using OPN super-high-pressure balloons up to 50 atm, followed by deployment of a drug-eluting stent (DES) with an excellent angiographic result. One month later, elective PCI addressed severe proximal circumflex (LCx) stenosis and a high-grade obtuse marginal (OM) branch lesion, treated with DES and drug-eluting balloon (DEB) therapy, respectively. This case highlights the natural history of coronary atherosclerosis in congenital coronary anomalies, the long-term durability of early-generation BMS, and the technical challenges posed by extreme calcification. It underscores the importance of lifelong surveillance and tailored revascularization strategies in patients with single-ostium coronary anatomy.
Kalpak et al. (Wed,) studied this question.