Isolated Coronary Artery

This image-based case report features a 64-year-old woman with hypertension who presented with chest pain at rest and exertion. ECG revealed T-wave inversions in the inferior leads, and elevated troponin (3.068 ng/mL) suggested myocardial injury. Echocardiography showed preserved ejection fraction (58%) with inferior wall hypokinesis and mild mitral regurgitation. Coronary angiography revealed absence of the left coronary ostium. Cannulation of the right coronary ostium uncovered an isolated coronary artery with severe mid-vessel stenosis and intracoronary thrombus. This solitary vessel mimicked the course of a right coronary artery but then extended posterolaterally into the atrioventricular sulcus, branching to supply the lateral and anterior walls. Stenting resolved the stenosis. The patient recovered and remained asymptomatic on dual antiplatelet therapy. Isolated coronary arteries are uncommon congenital anomalies, often discovered incidentally during angiography.

This image-based case report features a 64-year-old woman with hypertension who presented with chest pain at rest and exertion. ECG revealed T-wave inversions in the inferior leads, and elevated troponin (3.068 ng/mL) suggested myocardial injury. Echocardiography showed preserved ejection fraction (58%) with inferior wall hypokinesis and mild mitral regurgitation. Coronary angiography revealed absence of the left coronary ostium. Cannulation of the right coronary ostium uncovered an isolated coronary artery with severe mid-vessel stenosis and intracoronary thrombus. This solitary vessel mimicked the course of a right coronary artery but then extended posterolaterally into the atrioventricular sulcus, branching to supply the lateral and anterior walls. Stenting resolved the stenosis. The patient recovered and remained asymptomatic on dual antiplatelet therapy. Isolated coronary arteries are uncommon congenital anomalies, often discovered incidentally during angiography.