Anomalous circumflex artery: Intravascular ultrasound imaging of dynamic compression and “two wire–two vessel” percutaneous intervention

An anomalous origin of the left circumflex is the most common congenital abnormality encountered in coronary angiography and it may selectively predispose to focal accelerated atherosclerotic disease. We report the case of a 54-year-old man who presented with non-ST elevation myocardial infarction and a characteristic retroaortic (proximal) culprit lesion in his anomalous circumflex artery. Intravascular ultrasound images illustrate the dynamic nature of the lumen compression. A “two wires–two vessel” angioplasty technique provided extra support and is recommended to facilitate successful anomalous circumflex percutaneous coronary interventions.