case_images: PMC10413884_01
case_images: The patient's 12-lead electrocardiogram (ECG): (A) The patient's baseline 12-lead ECG with the subtle SAFS:challenging to interpret or recognize without the South African flag overlay. There is 3-mm ST-segment elevation in leads I, aVL, and V2, with ST-segment depression in lead III. (B) The patient's 12 lead ECG was superimposed over the South African national flag. The pattern of ST-segment elevation in leads I, aVL, and V2 with ST-segment depression in leads III coincides with the green stripe on the flag (green triangles and yellow triangles, respectively).
case_images: 10.1177_23247096231192861-fig1.jpg
case_images: PMC10413884_01_10.1177_23247096231192861-fig1.jpg
case_images: fig1-23247096231192861
case_images: STE in leads I, aVL, and V2 with ST-segment depression (STD) in lead III (Figure 1). She was immediately administered an ACS protocol with aspirin, ticagrelor, and atorvastatin and proceeded directly to the cardiac catheterization laboratory (Allura Xper FD20; Philips Healthcare, Amsterdam, the Netherlands) for primary percutaneous coronary intervention.
case_images: The patient's primary percutaneous coronary intervention (PPCI) series: (A) Left anterior oblique (LAO) cineangiography indicating a middle posterior left ventricular (PLV) artery 90% stenosis:encircled in red. (B) Right anterior oblique (RAO) caudal cineangiography indicating a middle left circumflex artery (LCx) 80% stenosis:encircled in red. (C) Left anterior oblique (LAO) caudal cineangiography indicating a thrombotic left anterior descending (LAD) artery occlusion, the so-called "widow-maker lesion":encircled in red. (D) Right anterior oblique (RAO) cranial cineangiography indicating the segment which was predilated with a drug-coated balloon (DCB) and subsequently stented with a drug-eluting stent (DES) with an excellent angiographic result without complications:encircled in red. (E) Straight cranial cineangiography indicating a now patent left anterior descending (LAD) artery with Thrombolysis in Myocardial Infarction (TIMI) III antegrade flow and no evidence of perforation or dissection:encircled in red.
case_images: 10.1177_23247096231192861-fig2.jpg
case_images: PMC10413884_01_10.1177_23247096231192861-fig2.jpg
case_images: fig2-23247096231192861
case_images: Coronary cineangiography revealed a 100% occlusion of the proximal LAD artery, 90% stenosis of the PLV artery and 80% stenosis of the LCx (Figure 2).