Tek Koroner Arter Anomalisi Zemininde Gelişen LAD–RCA Bifurkasyon Lezyonunun Girişimsel Tedavisi
Özet
Koroner arter anomalileri çoğu kez rastlantısal saptansa da bazı anatomik varyantlar önemli klinik sonuçlara yol açabilir. İzole tek koroner arter anomalisi bu grubun nadir bir alt tipidir. Bu bölümde, tek sol koroner ostiyumdan kaynaklanan koroner sistemde sol ön inen arter (LAD) ile LAD’den anormal köken alan sağ koroner arter (RCA) ayrımında kritik aterosklerotik lezyon gelişen 59 yaşındaki erkek olgu sunulmaktadır. Hasta, son iki aydır aralıklı olup son günlerde şiddetlenen göğüs ağrısı ile başvurdu. Seri kardiyak belirteçler ve ekokardiyografi bulguları ST-segment yükselmesiz miyokard enfarktüsü ile uyumluydu. Koroner anjiyografide LAD, LAD’den köken alan RCA ve sirkumfleks arterde kritik darlıklar saptandı. Konsey kararıyla LAD–RCA bifurkasyonu ve sirkumfleks lezyonuna perkütan koroner girişim uygulandı; başarılı revaskülarizasyon sağlandı. Olgu, nadir koroner anatomilerde ayrıntılı anatomik çözümleme ve lezyona özgü girişimsel planlamanın önemini göstermektedir.
Coronary artery anomalies are often detected incidentally, but certain anatomic variants may have important clinical consequences. Isolated single coronary artery anomaly is a rare subtype within this spectrum. This chapter presents a 59-year-old man with a single left coronary ostium and a critical atherosclerotic lesion at the bifurcation of the left anterior descending artery (LAD) and an abnormally originating right coronary artery (RCA) arising from the LAD. He presented with intermittent chest pain over two months that had recently worsened. Serial cardiac biomarkers and echocardiographic findings were consistent with non–ST-segment elevation myocardial infarction. Coronary angiography demonstrated critical stenoses in the LAD, the RCA originating from the LAD, and the circumflex artery. After multidisciplinary evaluation, percutaneous coronary intervention was performed for the LAD–RCA bifurcation and circumflex lesions, achieving successful revascularization. This case highlights the importance of detailed anatomic assessment and lesion-specific interventional planning in rare coronary anatomies.
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