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Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management.

Anomalous origin of left main coronary artery or right coronary artery from the aorta with subsequent coursing between the aorta and pulmonary trunk is rare and can be sometimes life threatening. After hypertrophic cardiomyopathy, coronary artery anomalies are the second most common cause of sudden cardiac deaths among young athletes. This is a case presentation of an anomalous origin of right coronary artery from left main coronary artery coursing between the pulmonary trunk and aorta. Patient presented with STEMI and had coronary bypass surgery.