Primary PCI in anomalous coronary: Wire first approach

Acute myocardial infarction in an anomalous coronary artery is an uncommon occurrence. Elective (PCI) percutaneous coronary intervention in anomalous coronary in stable CAD is challenging. We report a case of Primary PCI in an unstable patient (recurrent VT) with anomalous coronary. Proximal portion of the occluded artery was delineated using non-selective injection of dye with inverted left judkins directed towards the ostium. The coronary guide wire was initially passed into the proximal lumen without guiding support by skilled manipulation over which the left judkins was engaged. The catheter was inverted when it engaged the anomalous ostium and the procedure was completed successfully.