J Lipid Atheroscler.  2012 Dec;1(2):105-109. 10.12997/jla.2012.1.2.105.

Protective Role of Intercoronary Communication between Right Coronary Artery with Chronic Total Occlusion and Normal Left Circumflex Artery against Recurrent Myocardial Ischemia

• Lee SH
• Park SH
• Ji AY
• Lee JH
• Jin M
• Song C
• Kim I
• Kim YJ
• Joung B

• KMID: 2198369
• DOI: http://doi.org/10.12997/jla.2012.1.2.105

Abstract

Intercoronary communication is a very rare congenital malformation, which differs from coronary collaterals in variable aspects. It is larger in diameter, extramural in location and more resembles normal mature arterial features histologically. There are no consensus for the definition of intercoronary communiations, but some reports have suggested their protective role against myocardial ischemia due to its dual blood supply system. We report the case of a 72 year-old male smoker who had chronic total occlusion at the proximal portion of right coronary artery, which was communicated with a normal left circumflex artery. Although the patient had chronic total occlusion and subsequent in stent restenosis, there were no presentations of acute coronary syndrome or myocardial infarction.

Keyword

Coronary vessels; Communication; Anomaly; Myocardial ischemia; Coronary occlusion

MeSH Terms

Acute Coronary Syndrome
Arteries
Consensus
Coronary Occlusion
Coronary Vessels
Humans
Male
Myocardial Infarction
Myocardial Ischemia
Stents

Figure

• 

  Fig. 1 In the first admission, coronary angiography showed total obstruction at RCA, and well developed collateral flows were observed (A, B). After the second stage PCI at RCA CTO lesion, the selective injection of the RCA showed retrograde filling of the whole LCx (C). In the selective injection of the LCA, retrograde filling reached only at the middle of the RCA (D).

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  Fig. 2 In the third admission, coronary angiography showed total obstruction at RCA with ISR (A, B). After successful PCI, the selective injection of the RCA showed retrograde filling of the whole LCx (C). Selective injection of the LCA, retrograde filling reached at the middle of the RCA (D).

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