Spider-Like Coronary Anatomy; the True Spider!

A 55 year-old man was admitted to the hospital with typical chest pain; the ECG and cardiac biomarkers were normal. He had a history of hypertension and coronary angiography (CAG) a year ago due to unstable angina pectoris and a drugeluting stent was implanted at the left anterior descending (LAD) coronary artery. CAG was performed at admission due to persistent chest pain and a single right coronary ostium was seen at the right coronary sinus, where LAD artery, left circumflex coronary (LCx) artery and right coronary artery (RCA) arose altogether. Non-significant plaques were seen at LAD and LCx, whereas RCA was obstructed from the middle segment and retrograde perfusion was observed (Figure 1A and 1B). The patient was treated conservatively and reported no chest pain 12 months later. The single coronary ostium is classified into 20 categories based on the ostium's location and our patient had characteristics of type IID3 (Figure 1C). Although type IID coronary anomaly has been described before, it has been reported only once and this is the second case of literature showing a single coronary ostium originating from the right coronary ostium.