Single Coronary Artery: A Comprehensive Review.

Single coronary artery (SCA) is a rare congenital coronary anomaly. This condition may lead to myocardial ischemia, angina pectoris, and even sudden cardiac death. Generally speaking, if there are no other heart abnormalities, a SCA can be entirely asymptomatic. However, it may also pose a serious threat to health and survival. A thorough understanding of its anatomical and clinical characteristics is essential for accurate diagnosis and risk assessment. Medical imaging plays an important role in the diagnosis of a SCA. Precise imaging not only enables identification of the anomaly subtype but also allows comprehensive evaluation of coronary anatomy, myocardial perfusion, and concomitant lesions, thereby providing critical guidance for clinical decision-making. From echocardiography and conventional coronary angiography to noninvasive modalities such as computed tomography angiography and magnetic resonance angiography, each imaging technique has distinct clinical applications. Based on current literature, this review focuses on recent advances in SCA, systematically summarizing its clinical and anatomical characteristics, major classification systems, imaging diagnosis, clinical implications, and high-risk patterns, with the aim of providing a reference for precise diagnosis and therapeutic strategies.