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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.

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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

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