We report the case of a rare anomaly of the right coronary artery originated from the middle third of the left anterior descending (LAD) coronary artery with a proximal atheromatous obstructive lesion immediately before the emergence of the right coronary artery (RCA). The patient underwent successful angioplasty with stent implantation in the left anterior descending coronary artery. Only 7 cases of this anomaly of distribution have been reported in the literature, but none of them was treated with percutaneous revascularization.