Role of coronary CT angiography in anomalous high take-off of right coronary artery with ST elevation myocardial infarction: a case report

Anomalous high take-off of the right coronary artery (RCA) ostium above the sinuses of valsalva is extremely rare. It was not well visualized on conventional coronary angiography. A 52-year-old man was referred to emergency department presenting as chest pain. Because electrocardiography showed ST elevation in the inferior lead, he underwent emergent cardiac catherization, which revealed mild stenosis in the left coronary artery. However, the ostium of the RCA could not be found arising from the coronary cusp despite using aortogram with pigtail. Intraprocedural coronary computed tomography angiography showed a near total occlusion in the middle RCA, which had an anomalous take-off from the left anterior superior aspect of the ascending aorta, 2 cm above the left main coronary artery. Judkins left 4 guiding catheter via femoral approach could be engaged in the ostium of RCA. Successful percutaneous angioplasty using the Guidezilla extension catheter as additional backup support was performed.