Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Dec 15;59(24):3183-3186.
doi: 10.2169/internalmedicine.5425-20. Epub 2020 Aug 4.

Acute Posterior-inferior Myocardial Infarction Caused by Total Occlusion Distal to the Apex of the Hyperdominant Left Anterior Descending Artery

Yusuke Kamizono  1 , Daisuke Ikeda  2
Affiliations
Case Reports

Acute Posterior-inferior Myocardial Infarction Caused by Total Occlusion Distal to the Apex of the Hyperdominant Left Anterior Descending Artery

Yusuke Kamizono et al. Intern Med. .

Abstract

A 77-year-old woman was admitted to our hospital with severe ongoing chest pain. Electrocardiography showed ST-segment elevation in the inferior leads and tall R waves in leads V1-2. Posterior-inferior myocardial infarction was diagnosed. Emergent coronary angiography (CAG) revealed the wrap-around left anterior descending artery (LAD) with total occlusion distal to the cardiac apex. She underwent percutaneous coronary intervention (PCI). Despite difficulty navigating the long and tortuous LAD, we successfully performed reperfusion of the wrap-around LAD. CAG post-PCI showed the posterior descending artery arising from the LAD, described as hyperdominant LAD.

Keywords: acute myocardial infarction; hyperdominant left anterior descending artery; percutaneous coronary intervention; total occlusion distal to the apex.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Twelve-lead ECG on admission. ECG showed ST-segment elevation in leads II, III, and aVF and tall R waves in leads V1-2 as well as ST-segment depression in leads I, aVL, and V3-6. ECG: electrocardiography
Figure 2.
Figure 2.
Emergent CAG on admission. (A) Left CAG showed total occlusion (white arrow) distal to the apex of the wrap-around LAD. (B) The RCA was short and non-dominant. CAG: coronary angiography, LAD: left anterior descending artery, RCA: right coronary artery
Figure 3.
Figure 3.
Primary PCI and CAG during PCI. (A) A 1.0×6-mm balloon (white arrow) was delivered using a Guideplus guide extension catheter (yellow arrow) and dilated at the culprit lesion. (B) CAG after balloon angioplasty showed TIMI grade 1 flow. (C) TA was performed after delivering an aspiration catheter (red arrow) to the distal lesion. (D) Coronary flow restoration with TIMI grade 2 flow was achieved. (E) CAG after successful PCI showed that the distal LAD was long enough to continue as the posterior descending artery with TIMI grade 3 flow. CAG: coronary angiography, LAD: left anterior descending artery, PCI: percutaneous coronary intervention, TA: thrombus aspiration, TIMI: thrombus in myocardial infarction
Figure 4.
Figure 4.
Coronary CT angiography showing hyperdominant LAD without significant stenosis or plaque. (A) Maximum intensity projection image. (B) Curved multiplanar reconstruction image. CT: computed tomography, LAD: left anterior descending artery
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Mok NS, Wu CW, Leung WS, Chan NY. Simultaneous anterior and inferior ST-segment elevation following occlusion of distal left anterior descending coronary artery. Int J Cardiol 87: 311-313, 2003. - PubMed
    1. Kim BG, Kim KH, Nah JC, Cho SW. Simultaneous left and right ventricular apical thrombi after occlusion of the wrapped left anterior descending artery. J Cardiol Cases 19: 153-156, 2019. - PMC - PubMed
    1. Andreou AY, Georgiou GM. A case of simultaneous anterior, inferior, and right ventricular ST-segment elevation myocardial infarction due to occlusion of the wrapped left anterior descending coronary artery. Turk Kardiyol Dern Ars 37: 285-287, 2009. - PubMed
    1. Javangula K, Kaul P. Hyperdominant left anterior descending artery continuing across left ventricular apex as posterior descending artery coexistent with aortic stenosis. J Cardiothoracic Surg 2: 42, 2007. - PMC - PubMed
    1. Thygesen K, Alpert JS, Jaffe AS, et al. . Third universal definition of myocardial infarction. Eur Heart J 33: 2551-2567, 2012. - PubMed

Publication types