Introduction: Coronary artery anomalies are found in 0.6%-1.5% of patients undergoing diagnostic coronary angiogram or intervention. (1) These arteries present a challenge for diagnosis and intervention particularly in case of acute myocardial infarction presenting with occluded aberrant coronary artery.

Case reports: We report three cases on acute myocardial infarction with ST elevation presenting with “culprit” lesions in aberrant coronary arteries. First case is thrombosis occlusion of dominant right coronary artery and thrombosis sub occlusion of circumflex artery which originate from right coronary cusp. Second case is thrombotic occlusion of right coronary artery which originate from left coronary cusp. Third case is thrombotic occlusion of dominant left anterior descend artery in situation of absence right coronary artery (“single coronary artery”). All three cases were successfully treated.

Discussion: Acute myocardial infarction associated with anomalous origin of coronary artery is very unusual. Only few cases have been reported in literature. The technical difficulties associated with interventions include improper visualisation, managing the balance between adequate guiding support and risk of dissection, and casual extreme significant curves that have to be overcome with guide wires and all other interventional material.

Conclusion: Appropriate anatomical knowledge about the course of aberrant vessels and selecting appropriate hardware leads to safe selective engagement of anomalous coronary artery which is very important for finishing intervention in safe and reasonably quick manner.