Abstract
Dual left anterior descending (LAD) coronary artery is a rare anatomical variant with significant clinical implications. Recognizing this variant is crucial for accurate diagnosis and effective management, particularly in the context of revascularization strategies. We present a 71-year-old male with a history of dyspnea on exertion with baseline wall motion abnormality on a transthoracic stress echocardiography irreversible after exercise. Coronary computed tomography angiography revealed a dual LAD system: The left short LAD (LAD1) originating from the left main coronary artery and the right LAD (LAD2) arising separately from the right coronary cusp, distinct from the right coronary artery ostium. Having different origins and courses, both LADs supply the LAD territory. Our case is notable for two main reasons: The rarity of this particular type of dual LAD anatomy and the unique course of the LAD2, which, to our knowledge, has not been described in any previous case report. Although rare, dual LAD coronary artery should be considered in patients with atypical short LAD. Comprehensive imaging and a thorough understanding of coronary artery variants are essential for accurate diagnosis and effective management.