We report the case of a 42-year-old female with proven anterior ischemia and an anomalous origin of the left main coronary artery (ALMCA) who underwent successful percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) guidance. Angiographic and IVUS images demonstrate features unique to the ALMCA. The epidemiology, pathophysiology, evaluation and management options, including technical considerations for percutaneous intervention, are discussed. The ALMCA from the right...