case_images: PMC11363188_01
case_images: Emergency coronary angiography (CAG) and intravascular ultrasound (IVUS) were conducted in response to a recurrence of chest pain one day ago. During coronary spasm: CAG showed (A) the entire segment of the left anterior descending (LAD) artery was slender, with mid-segment narrowing of 95%-99% (white arrow), and (B) the entire segment of the right coronary artery (RCA) was slender, with part of the segment narrowing 95%-99% (white arrow); (C) myocardial bridging (red arrow), with the minimum luminal area of the LAD at 2.19 mm2. During non-coronary spasm: (D) the entire segment of the LAD was significantly dilated compared to before, with segmental narrowing resolved (white arrow); (E) the entire segment of the RCA was significantly dilated compared to before, with segmental narrowing disappeared (white arrow); (F) follow-up IVUS showed that the luminal area at the initially narrowest point had recovered to 8.81 mm2.
case_images: fcvm-11-1398675-g001.jpg
case_images: PMC11363188_01_fcvm-11-1398675-g001.jpg
case_images: F1
case_images: Supplementary Figure S1B): (1) Sinus rhythm, 74 beats per min; (2) Slight elevation of the ST segment and T-wave changes in leads V1-V5. Serial measurements of high-sensitivity troponin I levels demonstrated an escalation: 0.052 ug/ml upon emergency presentation, 1.146 ug/ml four hours post-admission, culminating at 4.333 ug/ml seven hours post-admission. Emergency coronary angiography demonstrated: (1) Absence of stenosis in the left main trunk, the left anterior descending (LAD) artery was slender with mid-segment 95%-99% narrowing (Figure 1A), with TIMI grade 2-3 blood flow; (2) The circumflex artery was slender with TIMI grade 3 blood flow; (3) No stenosis observed in the right coronary artery, with TIMI grade 3 blood flow; (4) The posterior lateral branch was slender with proximal 95%-99% stenosis (Figure 1B), with TIMI grade 2-3 blood flow. Intravascular ultrasound (IVUS) of the left anterior descending (LAD) branch reveals: negative remodeling of the mid-LAD lumen with concurrent coronary artery myocardial bridging, presenting a minimal luminal area of 2.19 mm2 (Figure 1C). Subsequent intracoronary administration of 100 mug nitroglycerin led to a re-evaluation angiogram which revealed: (1) Mid-segment myocardial bridge of the LAD, with 50% compression of the LAD during systole, and TIMI grade 3 blood flow (Figure 1D); (2) No narrowing in the posterior lateral branch, with TIMI grade 3 blood flow (Figure 1E). Follow-up IVUS of the LAD indicated the mid-segment myocardial bridging, with the original narrowest lumen area restored to 8.81 mm2 (Figure 1F).