Coronary Conundrum: Anomalous Pan-Coronary Origin from the Right Sinus with a “Type X” Dual LAD

A 49-year-old man presented with acute onset chest pain and new-onset right bundle branch block. Echocardiography revealed mild apical hypokinesia with an ejection fraction of 45%. Coronary angiography showed all three major coronary arteries originating from the right coronary sinus with normal flow. Further evaluation identified an obstructed accessory left anterior descending (LAD) artery arising from the left sinus. Successful wire crossing, balloon dilatation, and deployment of a drug-eluting stent restored TIMI 3 flow. Subsequent computed tomography angiography confirmed a rare Type X dual LAD anatomy. This case highlights the importance of recognizing uncommon coronary artery anomalies since they may significantly influence diagnostic and therapeutic strategies.