Focal Coronary Atherosclerosis Proximal to Myocardial Bridging
A 61-year-old man presented for evaluation of retrosternal chest pain. Coronary angiography displayed an eccentric stenosis of the proximal left anterior descending coronary artery (LAD; Figure 1). Otherwise, the coronary vasculature revealed only minimal irregularities.
The LAD was successfully revascularized by primary implantation of a 3.5×12 mm stent. The post-interventional angiogram revealed no residual stenosis. Interestingly, exten- sive myocardial bridging involving the mid-LAD as well as a prominent first diagonal branch was observed distal to the lesion (Figure 2, Movie).
This case is remarkable because it exemplifies focal coronary atherosclerosis proximal to myocardial bridging. This phenomenon presumably results from turbulent blood flow and elevated wall stress at vessel sites proximal to myocardial bridging.
The Movie is available as an online-only data supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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