An abnormal finding in an angiogram

An 80 year old Chinese gentleman was admitted with NSTEACS characterized by anterior T wave inversion and raised Troponin T. His coronary angiogram showed stenosis of the proximal LAD. He underwent PCI to LAD lesion. The RCA was large and there was large collateral between, RCA and PA (fig ), which was not intervened. He made good recovery and has been asymptomatic for over 2 years. Coronary artery anomalies are found in 1% of the population, RCA is the most commonly involved. Best approach would be to observe the patients, as most of them do not develop any symptoms.