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A 75-year-old woman with hypertension, hypothyroidism, and diabetes was referred to the catheterization laboratory due to non-ST segment elevation myocardial infarction. Urgent coronary angiography was uneventfully performed via right distal transradial access, despite lusoria subclavian artery. Left anterior descending artery was successfully treated by percutaneous coronary intervention with stenting. A TR band was left in situ for 60 minutes and completely removed after 2 hours, without bleeding. Proximal and distal radial pulses were palpable after hemostasis and at hospital discharge, 24 hours later, uneventfully. Six days after, she noticed subtle and rapidly progressive wrist, hand and fingers swelling, with pain, ecchymosis, and movement limitation.

The adoption of distal transradial access (TRA) as default approach for coronary angiography and interventions was recently published. As a refinement of conventional (proximal) TRA, this technique has advantages in terms of patient and operator comfort and risk of radial artery occlusion. We report herein a very challenging case of coronary angiography followed by complex percutaneous coronary intervention via right distal TRA, with aberrant (lusoria) subclavian artery, in the setting of non-ST segment elevation acute myocardial infarction complicated by refractory electrical storm.

Coronary artery anomalies (CAA) are congenital changes in their course, origin and/or structure. Most of them are incidentally discovered during autopsies or angiographic studies. We present the case of a 48-year-old woman with high-risk unstable angina whose coronary angiogram revealed an interesting and extremely rare coronary anomaly circulation pattern.

Coronary artery anomalies (CAA) are congenital changes in their origin, course and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or autopsies. A vessel is considered superdominant when it supplies the myocardium normally perfused by the other vessel. The occurrence of a superdominant left circumflex (LCx) artery supplying the territory of the right coronary artery (RCA) is extremely rare. We present the case of a 64-year-old woman complaining of stable angina at moderate efforts, with a positive treadmill test, referred to angiography, which incidentally revealed a very rare and interesting coronary anomaly circulation pattern.