This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Knaapen, P. Articles by de Cock, C. C. Search for Related Content PubMed PubMed Citation Articles by Knaapen, P. Articles by de Cock, C. C. Related Collections Imaging Coronary circulation

(Circulation. 2006;114:e501-e502.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Coronary Collaterals in Full Effect

Paul Knaapen, MD; Lucas J. Klein, MD; Robin Nijveldt, MD; Tjeerd Germans, MD; Albert C. van Rossum, MD, PhD; Carel C. de Cock, MD, PhD

From the Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.

Correspondence to P. Knaapen, MD, Department of Cardiology, 6D 120, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail p.knaapen@vumc.nl

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 59-year-old man with no relevant medical history was referred to our clinic for analysis of exertional chest pain. He had noticed slowly progressive symptoms approximately 6 months before referral, although they did not prohibit his daily 12-mile cycling exercise routine. During diagnostic 99m-technetium-sestamibi single photon emission computed tomography treadmill stress testing, the ECG showed pathological ST-segment depression, and the patient had anginal chest pain. Three-dimensional reconstructed scintigraphic perfusion images (Figure 1) displayed a substantial reversible defect in the anterolateral myocardium with only a mild resting perfusion defect in the distal segment of the anterior wall, which coincided with a small area of subendocardial fibrosis visualized by late contrast-enhanced magnetic resonance imaging (Figure 2). Apart from hypokinesia in this segment, contractile function of the left ventricle was normal (online-only Data Supplement Movies I and II). After the nuclear stress test, the patient was admitted and treated with aspirin, ß-blockers, and statins, and coronary angiography was performed. Injection of the contrast agent in the right coronary artery (Figure 3A through Figure 3C, Movies III and IV) revealed an extensive collateral network with complete retrograde filling of the epicardial vessels of the left anterior descending and circumflex artery (grade 3/3 according to the Rentrop collateral flow classification).¹ Conversely, there was complete occlusion of the left main coronary artery (Figure 3D, Movie V). No attempts for percutaneous intervention were made, and successful coronary artery bypass grafting was performed within a few days, with subsequent . . . [Full Text of this Article]