Large intercoronary communication between the right coronary artery and the left circumflex artery in a patient with late stent thrombosis: A case report

Intercoronary communication (ICC) is a very rare coronary artery anomaly that connects directly 2 coronary arteries. This anastomosis is found between 2 nonobstructed coronary arteries with unidirectional or bidirectional blood flow. We report a case of a large ICC between the right coronary artery and the left circumflex artery in a patient with late stent thrombosis. The electrocardiogram showed ST-segment elevation in the anterior leads. The echocardiography investigation revealed hypokinesis in the proximal, medial and apical segments of the interventricular septum and anterior wall as well as the apex. During invasive coronary examination a large ICC between the left circumflex artery (LCx) and the right coronary artery (RCA) was found. Furthermore, coronary angiography demonstrated proximal occlusion (stent thrombosis) of the left anterior descending artery (LAD), prompting the utilization of percutaneous intervention with a drug-eluting stent. The presence of a large intercoronary communication is an exceedingly uncommon anomaly of the coronary arteries, which has the potential to induce myocardial ischemia. In individuals with obstructive coronary artery disease, this anomaly can further worsen the existing condition.