Single coronary artery presenting with ST-segment elevation myocardial infarction

Excerpt

A 52-year-old man with no history of cardiovascular disease was admitted to the emergency room with severe chest pain lasting 4 h. Electrocardiography (ECG) revealed ST-segment elevation in leads D₂-D₃-aVF-V₅, and V₆. He was immediately transferred for angiography and diagnosed with acute inferolateral myocardial infarction. Left-system angiography with a Judkins left catheter showed no vessels originating from the left coronary sinus. Right-system angiography revealed the left main coronary artery (LMCA) originating from the proximity of the right coronary artery, tracking an unusual course to the left side and dividing into the left anterior descending and left circumflex(LCx) artery; the LCx artery was totally occluded just after the division (Fig. 1 and Video 1). The LMCA originating from the right coronary sinus was cannulated with a Judkins left 3.5 guiding catheter and the totally occluded LCx artery was crossed with a floppy guidewire (Fig. 2). First, predilation with a 2.0 × 20-mm balloon catheter was performed (Fig. 3). After predilation, a 3.0 × 18-mm bare metal stent was implanted (Fig. 4) and grade-3 thrombolysis in myocardial infarction flow was ensured (Fig. 5 and Video 2). ECG after the procedure showed successful ST-segment resolution; the patient’s chest pain was relieved. …