Congenital Absence of Left Main Trunk – CCTA Evaluation of a Patient with Ischemic Heart Disease

Coronary artery anomalies represent a heterogeneous group of congenital diseases with various clinical presentations. Over time, the subject of coronary anomalies has been constantly changing in terms of definition, morphology, clinical manifestations, prognosis, and treatment. We present the case of a male patient, aged 53, with coronary artery disease and a medical history of high blood pressure and diabetes mellitus, who had undergone a coronary computed tomography angiography during the one-year follow-up after a percutaneous coronary intervention with drug-eluting stent implantation for a critical stenosis in the middle segment of the left anterior descending artery. Axial images revealed a separate origin of the left anterior descending and circumflex arteries from the left aortic coronary sinus, with the absence of the left main coronary artery.