Navigating ALCA-R Complexity: Clinical Presentation, Imaging, and Management

Abstract

This case study explores the diagnostic challenges and management of Aberrant Left Coronary Artery Arising from the Right Coronary Sinus (ALCAR), a rare coronary anomaly. Through advanced cardiac imaging, including coronary angiography and CT coronary angiography, the report highlights the importance of accurate diagnosis in a 69-year-old male with recurrent chest pain during exercise. ALCA-R, though less common, presents unique diagnostic challenges and is considered more perilous than its counterpart. With a prevalence of approximately 0.15%, ALCA-R exhibits diverse anatomical variations, emphasizing the role of advanced cardiac imaging in classification and management decisions. A 69-year-old male with recurrent chest pain during exercise underwent coronary angiography and CT coronary angiography, revealing an ALCA-R with a sub-pulmonic subtype. The anomalous artery traversed the right ventricular outflow tract, pulmonary infundibulum, and interventricular septum. Recognition of ALCA-R's clinical implications is crucial, especially in patients with recurrent chest pain during exertion. Classified by course, ALCA-R includes categories like inter-arterial, intra-myocardial, retro-aortic, and anterior. Accurate diagnosis through advanced imaging guides intervention and risk assessment. A multidisciplinary team evaluated the patient, including cardiologists and cardiac surgeons. Treatment options, including potential surgical correction, were discussed based on specific anatomical considerations identified through imaging. This case study provides insights into the clinical and imaging aspects of ALCA-R, emphasizing the importance of accurate diagnosis and interdisciplinary collaboration for optimal patient care. The goal is to enhance awareness and proactive management of rare coronary anomalies. Aberrant Left Coronary Artery, ALCA-R, sub-pulmonic type, Coronary Anomalies, Coronary CT Angiography.