Rota-stenting of a calcified anomalous left coronary artery via the arm in a multi-vasculopathic patient.

Anomalous origins of the coronary arteries pose a challenge to the interventionalist. Diagnostic testing must take into account the possibility that perfusion patterns may be unusual but not pathologic, resulting in false-positive perfusion scanning. Treatment strategies must be customized to allow unusual access and passage of devices around angulations not commonly encountered. In this report, we describe a patient with severe peripheral arterial disease requiring the use of a 7 French multipurpose guide via the brachial approach for rotational atherectomy and stenting of a calcified and angulated anomalous left coronary.