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An anomalous right coronary artery underwent successful percutaneous transluminal coronary angioplasty (PTCA) but exercise-induced myocardial ischemia persisted. Moreover, recurrent restenosis were angiographically documented and treated by repeat PTCA. Post-PTCA large atheroma burden not appreciable by angiography, high take-off, and tangential origin of the vessel from the aorta may be some of the mechanisms involved in myocardial ischemia persistence and restenosis of the vessel.
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