case_images: PMC11122690_01
case_images: Initial coronary angiogram. (A) 80% stenosis of the left main artery, 40% stenosis in the proximal left anterior descending artery. (B) Right coronary artery had an anomalous origin from the ascending aorta.
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case_images: F1
case_images: Coronary angiography was subsequently performed and demonstrated 80% stenosis of the mid-left main artery (LMA) and 40% stenosis in the proximal-mid left anterior descending artery (LAD) (Figure 1). The right coronary artery (RCA) had an anomalous origin from the ascending aorta (Figure 1). Repeat coronary angiogram was performed (Figure 3A, Video 1).
case_images: Coronary computed tomographic angiography (CCTA). (A) Diffuse narrowing of the left main artery with 70-80% maximal stenosis; CCTA reformat depicts diffuse narrowing of the left main artery resulting in 40-50% stenosis (arrow). (B) Curve planar reformat of the left anterior descending (LAD) shows diffuse circumferential wall thickening of the proximal LAD resulting in up to 50% stenosis (arrow). Incidental 1.4-cm myocardial bridge involves the mid-LAD without extrinsic compression or significant intraluminal stenosis (*). (C) 3-dimensional volume rendering of the coronary tree demonstrates high takeoff of the right coronary artery from the anterior surface of the ascending aorta (arrow).
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case_images: F2
case_images: CCTA showed severe diffuse narrowing of the LMA with 70% to 80% maximal stenosis, mild nonobstructive coronary artery disease (CAD) in the proximal LAD and mid-RCA (Figure 2). Intracoronary NTG was administered and relieved the vasospasm with improvement of LMA stenosis from 70% to 20% (Figure 3B, Video 2).
case_images: Repeat coronary angiogram. Pre-nitroglycerine coronary angiogram with changed severity and distribution of left main artery (LMA) stenosis compared to recent prior coronary angiogram (Figure 2). Coronary angiogram after intracoronary nitroglycerin administration with improvement in LMA stenosis and improved downstream blood flow.
case_images: mdcvj-20-1-1365-g3.jpg
case_images: PMC11122690_01_mdcvj-20-1-1365-g3.jpg
case_images: F3
case_images: Repeat coronary angiogram was performed (Figure 3A, Video 1). Intracoronary NTG was administered and relieved the vasospasm with improvement of LMA stenosis from 70% to 20% (Figure 3B, Video 2).
case_images: Initial coronary angiogram pre-intracoronary nitroglycerin administration; see also at https://youtu.be/3oVymC12vP8.. Repeat coronary angiogram after intracoronary nitroglycerin; see also at https://youtu.be/pXcMcIz8Vkw.
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case_images: PMC11122690_01_.jpg
case_images: V1
case_images: Subsequently, intravascular ultrasound (IVUS) showed a minimal luminal area (MLA) of 8.9 mm2 with mild-moderate plaque burden in the LMA (Figure 4).