The Great Masquerade: Not All Coronary Artery Stenosis Are Created Equal

Figures

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  Figure 1. 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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  Figure 2. 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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  Figure 3. 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.

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  Figure 4. Intravascular ultrasound (IVUS) of the left main artery showing minimal luminal area of 8.9 mm2 and mild-moderate plaque burden.