Is the left anterior descending artery really absent?—A decisive input from coronary CT angiography

This case report emphasizes the importance of coronary CT angiography (CTA) as a backup imaging modality in patients with suspected coronary anomalies and difficult cannulation, during invasive coronary angiography by catheterization (Cath). In this patient, the numerous cannulation attempts during Cath failed to identify a left anterior descending artery (LAD) leading to the diagnosis of absent LAD. CTA was done for further clarification, which easily visualized LAD originating from a separate ostium at the left sinus of Valsalva finalizing the diagnosis as absent left main artery with dual left coronary ostia.