Human coronary artery anatomy would rank top among all human biological mysteries. The variations in their branching pattern is next only to palmar creases and cerebral gyri !
The left coronary artery can divide in to two , three or even four branches occasionally.The trifurcation occurs in upto 20 % of population .The ramus intermedious can some times be a major division .Usually it supports the diagonal or OM territory.
It is very rare to see a ramus take a long course . Here is a patient whose LAD is small which falls short of LV apex . Sensing this , the ramus travels all the way to apex and support the LAD in distress !
RAO caudal view shows the Ramus reaching all the way to LV apex! Note the diminutive LAD and absence of true OMs from LCX.
* Technically this can also be referred to as a rare form of dual LAD system .
Dr.S.Venkatesan MD 
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