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(Circulation. 2005;111:e113-e114.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Unexpected Profound Transient Anterior ST Elevation After Occlusion of the Conus Branch of the Right Coronary Artery During Angioplasty

J. Eichhöfer, PhD, MRCP; N. Curzen, PhD, FRCP, FESC

From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom (J.E.), and Wessex Cardiac Unit, Southampton University Hospital, Southampton, United Kingdom (N.C.).

Correspondence to J. Eichhöfer, PhD, MRCP, Specialist Registrar in Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, United Kingdom. E-mail jonas@eichhoefer.freeserve.co.uk

An extract of the first 100% of the full text is provided, because this article has no abstract.

A 71-year-old male smoker presented with chest pain. The admission ECG showed transient lateral ST elevation that resolved before thrombolysis could be given. Coronary angiography revealed a severe proximal and a further midvessel stenosis in the right coronary artery (RCA; Figure, A). There was no obstructive disease in the left coronary artery. The midvessel RCA lesion was stented uneventfully. A second overlapping stent was then deployed to cover the proximal stenosis. The conus branch was occluded as a result of this stent (white arrow in panel B of the Figure), whereas the right ventricular branch remained patent (black arrow in panel B of the Figure). The patient developed chest pain immediately, and the ECG showed marked ST elevation in V₁ through V₃ (Figure, C). The left coronary artery remained unobstructed (Figure, D). The ECG changes resolved within 15 minutes. Creatinine kinase was 175 IU/L 1 hour after the procedure (reference: 25 to 195 IU/L) and 307 IU/L the next morning. Anterior ST elevation due to occlusion of a right ventricular RCA branch has been reported previously and is thought to be a mirror image of right ventricular ischemia. This is a profound example of this phenomenon, caused by acute conus branch occlusion.

View larger version (142K): [in this window] [in a new window]   A, RCA before intervention; B, RCA after stents deployed, showing occlusion of conus branch; C, ECG immediately after insertion of proximal RCA stent; and D, Left coronary artery angiogram during ST elevation, immediately after RCA intervention.