Author + information
- S. Hinan Ahmed, MD⁎ ()
- ↵⁎University of Texas Health Sciences Center, Division of Cardiology, 7703 Floyd Curl Drive, MSC 7872, San Antonio, Texas 78229
We thank Dr. Angelini for his interest in our paper (1) and agree that the ectopic origin and the intramural course of the right coronary artery (RCA) did in fact contribute partly to the clinical presentation of longstanding angina and large inferolateral ischemia. Further evaluation after the stenting of circumflex artery included a significant fractional flow reserve (FFR) of 0.78 in the RCA. We proceeded with primary stenting of proximal RCA with a 4.0 × 15-mm drug-eluting stent (Promus, Boston Scientific, Natick, Massachusetts) followed by post-dilation with a noncompliant balloon and a post-procedure FFR of 0.93. Due to space limitations, this was not included in the initial case report.
The clinical and prognostic implications of an RCA arising from an anomalous cusp and traversing an intramural/inter-arterial course ranges from benign through causing angina to sudden cardiac death (2). To make the distinction and facilitate management, adjunctive modalities such as intravascular ultrasound (3) and FFR (4,5) have been used in a small number of cases. In our patient both involved arteries supplied a large area of myocardium, and thus any significant stenoses would most likely cause ischemia.
- American College of Cardiology Foundation
- Eshelbrenner C.,
- Ahmed S.H.
- Park K.,
- Koo B.K.,
- Oh I.Y.,
- et al.