The Coronary Crown

Anomalies of coronary artery are rare but can be clinically significant. Anomalous coronary artery origins are rare but clinically significant. We present a 50-year-old man with an inferior myocardial infarction who successfully underwent thrombolysis. Coronary angiography revealed a totally occluded right coronary artery and a rare anomaly: separate origins of the left anterior descending and left circumflex arteries from the right coronary sinus. Subsequent multidetector computed tomography confirmed a benign prepulmonic left anterior descending and retroaortic left circumflex course. The patient underwent successful percutaneous coronary intervention with drug-eluting stents to the right coronary artery and a ramus intermedius lesion and was discharged as asymptomatic. This case highlights the critical role of multimodality imaging in delineating complex coronary anatomy to guide safe and effective revascularization. Multimodality imaging is crucial for accurately delineating complex coronary anatomy to ensure optimal risk stratification and guide safe revascularization.