Wrap-around LAD and the role of multimodal imaging

Acute myocardial infarction remains a major cause of morbidity and mortality, with the left anterior descending artery being most commonly implicated. Anatomical variants, such as the "wrap-around" configuration, can significantly influence myocardial perfusion patterns, infarct size, and clinical outcomes, emphasizing the importance of accurate identification in acute coronary syndromes. We present the case of a 72-year-old male with ST-segment elevation myocardial infarction (STEMI), whose initial electrocardiogram indicated an anteroseptal infarction. Due to limited access to catheterization facilities, thrombolytic therapy was administered, achieving successful reperfusion. A subsequent multimodal imaging assessment revealed an atypical infarct distribution and identified a wrap-around left anterior descending artery with critical stenosis, highlighting the variant's diagnostic and therapeutic relevance in STEMI management and the utility of multimodal imaging.