All three coronary arteries and a separate conus branch arising from the right sinus of Valsalva in an octogenarian with an acute myocardial infarction: a case report

This constellation, a separate ostia of four coronary arteries arising from the right coronary sinus, is exceedingly rare. The case underscores several practical points. Anomalous coronaries are susceptible to atherosclerosis and should be revascularized according to clinical context and not anomaly <i>per se.</i> Furthermore, meticulous catheter manipulation should be performed in order to avoid transient ostial compromise of small branches, such as in our case. Finally, CTCA complements invasive angiography by clarifying spatial relationships essential for risk stratification.