Left anterior descending artery of anomalous origin; Native lad arises from left internal mammarian artery. A case report and article review

Coronary artery anomalies are encountered in 2.6% of the population. Left anterior descending artery (LAD) stemming from a separate ostium is seen at a rate of 0.48%. In this case, we reported on a left internal mammarian artery (LIMA) giving rise to LAD. Coronary angiography was performed through the right radial artery in 54-year-old female patient. It did not reveal the presence of left main coronary artery in all three aortic sinuses. Pulmonary angiography also did not demonstrate LAD stemming from the pulmonary artery. Then, the LIMA was selectively visualized, and LAD originating from LIMA was observed. The PubMed database contains no reports of LIMA giving rise to LAD. This is the first case report demonstrating LAD originating from LIMA. Accordingly, if LAD cannot be visualized during angiography, an angiographic image of LIMA should be taken before a diagnosis of atresic LAD. For angiographic examination, the right radial route can be used.