Coil closure of lumbar artery pseudoaneurysm: An unusual complication associated with anomalous left circumflex artery primary percutaneous coronary intervention

The presence of anomalous coronary arteries is observed in approximately 1% of patients undergoing coronary angiography (CAG). In these patients, identification of the stenotic ostium and revascularization is difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI). Among the congenital coronary anomalies, separate anomalous origin of all the coronary arteries from the right sinus of Valsalva is very uncommon. Failure to identify the anomalous origin of coronary arteries can lead to in correct diagnosis and prolonged procedures, which can result in serious complications, especially in the setting of acute myocardial infarction. A male patient 60 years old presented with acute inferior and posterior wall myocardial infarction with postmyocardial infarction (MI) angina. On evaluation his ECG revealed sinus rhythm, q II,III, aVF, Tall T in V1, V2. Two dimensional (2D) Echo showed regional wall motion abnormalities of the inferior & posterior walls, a moderate degree of MR, Gr II diastolic dysfunction, and an EF of 47% with good RV function. Biochemical values were within normal limits. TROP Twas positive. In view of rest angina, the patient was taken for early revascularization. His coronary angiogram revealed dominant left system and left circumflex artery (LCX) with total occlusion, arising from the right sinus (Fig. 1). The LCX was engaged with an AL1 catheter (Amplatz