Case Report: The aslanger pattern as an indicator of severe acute coronary syndrome

Figures

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  Figure 1. Electrocardiographic and angiographic findings. Red arrows indicate the J-point on ECG; red dashed lines and blue text denote ST-segment deviation. Red labels on angiograms indicate coronary arteries; blue arrows indicate lesion locations. (A): Initial ECG showing ST-segment elevation in lead III, ST-segment depression in leads I and II, and ST-segment depression in leads V2–V6 with terminal T-wave positivity. (B): Post-procedural ECG showing normalized ST segments in lead III and V2–V3, with persistent though improved ST-segment depression in V4–V6. (C): Angiogram of LAD and LCX. The LCX showed diffuse plaques with 90%–95% stenosis in its mid-segment (length: 15 mm; RVD: 2.5 mm; TIMI flow grade III). The LAD had multiple plaques from proximal to mid-segment (RVD: 2.5 mm; lesion length: 20 mm). The first diagonal branch (D1) exhibited 90%–95% diffuse stenosis (RVD: 1.5 mm; length: 30 mm; TIMI III).(D): RCA angiography revealed 60%–90% stenosis in the mid-segment (RVD: 2.5 mm) and 80%–95% diffuse stenosis just before the distal bifurcation, with extensive calcification (TIMI III).(E): RCA after revascularization, showing restored flow.

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  Figure 2. Timelines of key clinical events for case 1 and case 2.

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  Figure 3. Electrocardiographic and angiographic findings (case 2). Red arrows indicate the J-point on ECG; red dashed lines and blue text denote ST-segment deviation. Red labels on angiograms indicate coronary arteries; blue arrows indicate lesion locations. (A): Emergency department ECG showing ST-segment elevation in leads III, aVR, and V1; ST-segment depression with positive terminal T-waves in leads I, aVL, and V2–V6; and absence of ST-segment elevation in leads II and aVF. (B): Pre-procedural ECG showing resolution of ST-segment deviations in most leads, with only mild residual ST depression in leads V4–V5. (C): Post-procedural ECG showing mild residual ST elevation in lead V1, with complete normalization in all other leads. (D): Pre-PCI angiogram showing 20%–30% stenosis at the left main (LM) ostium; 90%–95% diffuse stenosis in the proximal LAD (RVD 3.0 mm, lesion length 55 mm, heavy thrombus burden, TIMI grade II flow); total occlusion of the proximal LCX (TIMI grade 0); and 60%–70% stenosis in the proximal OM1. (E): Post-PCI angiogram showing significantly improved stenosis in the LCx and OM1 (TIMI grade III flow) and resolution of stenosis in the proximal to mid LAD (TIMI grade…