title: Percutaneous intervention on anomalous circumflex coronary arteries--a single centre experience.
abstract: BACKGROUND
  Anomalies of the origin and course of the circumflex artery are amongst the most common seen at coronary angiography. There is limited information regarding patient and procedural characteristics, technical feasibility and outcomes associated with percutaneous intervention (PCI) to these vessels. The aim of this study is to examine our experience with PCI to anomalous circumflex vessels and compare this to some aspects of percutaneous intervention on non-anomalous circumflex vessels.
  
  
  METHODS
  Over a 41 month period, 20 PCI procedures on anomalous circumflex vessels were identified and 1550 PCI procedures on non-anomalous circumflex arteries.
  
  
  RESULTS
  In 9 anomalous cases, the circumflex arose from the left coronary cusp, in 7 cases from the right coronary cusp, and in the remaining 4 cases from the proximal right coronary artery. There were no differences in demographics or pattern or severity of coronary disease between the 2 groups. A higher proportion of patients with anomalous vessels presented acutely. Screening times were longer in the anomalous group. All 20 procedures were associated with immediate procedural success. There was one peri-procedural myocardial infarction unrelated to anomalous circumflex intervention. After a median follow-up period of 7.3 months, the only major adverse cardiac event recorded in the anomalous group was an ischaemia-driven revascularisation to a non-target vessel branch. We describe techniques which can be used to improve support and facilitate successful PCI to anomalous circumflex vessels.
  
  
  CONCLUSIONS
  PCI to anomalous circumflex vessels may be technically challenging, but is feasible and carries favourable short and long-term clinical outcomes.
  
  
  CONCLUSIONS
  This single centre observational study demonstrates that percutaneous coronary intervention to anomalous circumflex coronary arteries although technically challenging can be performed with satisfactory procedural success rates and favourable short and longer-term clinical outcomes. It describes various techniques that can be employed to optimise successful intervention.
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Morgan
authors.forename: Gwilym M
authors.initials: GM
authors.lastname: Morris
authors.forename: Yahya
authors.initials: Y
authors.lastname: Al-Najjar
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.forename: Farzin
authors.initials: F
authors.lastname: Fath-Ordoubadi
authors.forename: Douglas
authors.initials: D
authors.lastname: Fraser
authors.forename: Vaikom
authors.initials: V
authors.lastname: Mahadevan
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
authors.forename: Magdi M
authors.initials: MM
authors.lastname: El-Omar
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016896:Treatment Outcome