Anomalous circumflex coronary artery: Benign or predisposed to selective atherosclerosis

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly and is usually considered beni gn. Although several researchers in the past believed that aberrancy predis poses this vessel to accelerated atherosclerosis, this could not get wide a cceptance owing to lack of convincing data. To examine the suggestion that atherosclerosis affects the anomalous circumflex artery more severely, the authors reviewed the clinical and angiographic features of patients with th is anomaly identified from 2,684 coronary angiography procedures per-formed between January 1998 and March 2000 at their institution. The degree of at herosclerotic narrowing in the anomalous artery was compared with that in o ther coronary arteries in the same patient as well as in the nonanomalous c ircumflex arteries in controls. For comparison 3 control subjects were selected for each patient with anoma lous circumflex artery, matched by age, sex, and clinical presentations. Th e results showed earlier and greater degree of atherosclerotic narrowing of the anomalous artery as compared to the other coronary arteries in the sam e patients as well as to nonanomalous circumflex arteries of age- and gende r-matched control subjects with similar clinical characteristics. However, this predilection for atherosclerosis was evident only in anomalous vessels arising from the right side and pursuing a retroaortic course. The anomalo us artery was responsible for myocardial infarction in 3 patients, all of w hom were 60 years or older. Two of the patients with this anomaly and myoca rdial infarction underwent successful angioplasty with stent placement for symptomatic relief.