case_images: PMC8588764_01
case_images: (A) PET perfusion images reveal a large, moderate to severe, reversible, myocardial perfusion defect in the LAD coronary artery vascular territory. (B) The calcium score was zero. (C) Myocardial blood flow analysis revealed reduced peak stress blood flow in the LAD territory but preserved global myocardial flow reserve. (D) Invasive angiographic images reveal severe stenosis in the proximal LAD that was (E) treated successfully with a drug-eluting stent. PET: positron emission tomography; LAD: left anterior descending artery.
case_images: mdcvj-17-4-845-g1.jpg
case_images: PMC8588764_01_mdcvj-17-4-845-g1.jpg
case_images: F1
case_images: The perfusion images revealed a large, moderate to severe intensity, completely reversible perfusion defect in the basal to distal anterior and antero-septal segments that was suspicious for ischemia in the left anterior descending (LAD) coronary artery vascular territory (Figure 1A). Surprisingly, the patient's calcium score (performed as a standard part of the PET exam) was zero (Figure 1B). Myocardial blood flow analysis revealed abnormal flow augmentation in the LAD territory (peak stress flow in the LAD 1.3 mL/min/g; expected normal > 1.8 mL/min/g) and normal flow augmentation in the rest of the coronary vessels (Figure 1C). The patient underwent coronary angiography, revealing a 90% proximal LAD lesion, which was treated with a (3.0 x 15) Resolute Onyx drug-eluting stent (Medtronic; Figure 1D and 1E).