case_images: PMC8348259_01
case_images: ECG was normal in September 2013
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case_images: F1
case_images: His electrocardiogram (ECG) (Figure 1) and his transthoracic echocardiogram were unremarkable.
case_images: ECG showed S-T depressed more than 0.4-0.5mm on I, II, aVF, V3-V6 leads and S-T elevated more than 0.3mm on avR lead (narrows) in November 2014
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case_images: PMC8348259_01_PAMJ-39-28-g002.jpg
case_images: F2
case_images: Electrocardiogram showed ST-segment depression of more than 0.4-0.5 mm on I, II, aVF and V3-V6 leads, and ST-segment elevation of more than 0.3 mm on aVR lead (Figure 2). The ECG and cardiac troponin -T level were unremarkable (Figure 5, Table 2).
case_images: A) coronary angiography showed serious stenosis of 85-90% in LM, 70-75% in LAD in November2014 (narrow); B) coronary angiography showed 80% in proximal and distal RCA in November 2014 (narrow)
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case_images: PMC8348259_01_PAMJ-39-28-g003.jpg
case_images: F3
case_images: The results showed serious stenosis of 85-90% in the left main coronary artery (LM), 70-75% in the proximal left anterior descending (LAD), 80-85% in the diagonal branch, and 80% in the proximal and distal right coronary artery (RCA) (Figure 3A,B).
case_images: A) a drug-eluting stent was implanted in LM and two in LAD in November 2014 (narrow); B) the proximal RCA was implanted two stents in November 2014 (narrow)
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case_images: PMC8348259_01_PAMJ-39-28-g004.jpg
case_images: F4
case_images: Percutaneous Coronary Intervention (PCI) was performed immediately, and one drug-eluting stent was implanted in the LM and two were implanted in the LAD (Figure 4A,B). One week after this interventional procedure, two stents were implanted in his proximal RCA (Figure 4A,B).
case_images: ECG was unremarkable in January 2015
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case_images: F5
case_images: The ECG and cardiac troponin -T level were unremarkable (Figure 5, Table 2).
case_images: A) coronary angiography showed that no abnormality was found in the stents of LAD and diagonal branch showed still 80% stenosis in January 2015; B) coronary angiography showed that no abnormality was found in the stents of RCA and distal vessel showed 80% stenosis in January 2015
case_images: PAMJ-39-28-g006.jpg
case_images: PMC8348259_01_PAMJ-39-28-g006.jpg
case_images: F6
case_images: Reexamination of coronary angiography showed that no abnormality was present in the stents, the diagonal branch of the LAD and the distal branch of the RCA still showed 80% stenosis (Figure 6A,B) Because the blood vessels were small, invasive intervention was not performed. The patient was again admitted to our hospital in April 2016 and June 2017 with complaints of chest pain, and coronary angiography showed no change in condition compared with that seen in January 2015 (Figure 6A,B).