case_images: PMC10701518_01
case_images: Coronary angiography for non-ST-elevation myocardial infarction. (A,B) Yellowish dashed arrow indicates the right coronary artery, and yellowish arrow indicates the left main coronary artery. Different views of anomalous aortic origin of a coronary artery with a common ostium.
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case_images: F1
case_images: Invasive coronary angiography showed a common origin of the right and left coronary arteries at the right coronary cusp with diffuse atherosclerosis and multiple stenotic lesions (Figure 1; Supplementary Video S1).
case_images: Coronary computed tomography angiography assessment for anomalous aortic origin of a coronary artery. (A) Reconstructive image revealed "right" main bifurcation. (B,C) Coronary computed tomography angiography showed a common ostium for the left main coronary artery and the right coronary artery, characterized by an interarterial course.
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case_images: F2
case_images: For detailed anatomy, we performed coronary computed tomography angiography (CCTA), which revealed an anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva and an interarterial course between the aorta and the pulmonary artery; the "right" main bifurcation angle was close to 180  (Figure 2).
case_images: Management of AAOCA stenosis. (A) Intravascular ultrasound (IVUS)-guided stent deployment. (B,C) White arrow indicates the proximal mark of the right coronary artery stent, positioned close to the center of the proximal left main coronary artery stent, in accordance with IVUS guidance. (D) Kissing balloon technique for ostium bifurcation. AAPCA, anomalous aortic origin of a coronary artery.
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case_images: F3
case_images: Two SYNERGY stents (4.5 mm x 24 mm and 5.0 mm x 12 mm) were deployed within the RCA from the orifice to middle part. (Figure 3; Supplementary Video S4). Afterward, the kissing balloon technique was used to ensure complete stent apposition in both orifices; to accomplish this, a noncompliance balloon catheter (4.0 mm x 15 mm; Conqueror, APT Medical, Shenzhen, China) was used for the LMCA and a noncompliance balloon catheter (5.0 mm x 12 mm; Emerge, Boston Scientific, Marlborough, MA, USA) was used for the RCA (Figure 3).
case_images: Final angiography. (A,B) Final angiography revealed improved flow.
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case_images: F4
case_images: The IVUS showed that the stents were well apposed without external compression on images, and the final angiography revealed improved flow (Figure 4; Supplementary Video S5).