Isolated inferior myocardial infarction due to wrap-around left anterior descending artery: case report

Acute occlusion of the left anterior descending (LAD) artery usually produces ST-segment elevation in anterior electrocardiographic leads and reciprocal depression in inferior leads. Inferior ST-elevation is typically associated with right coronary artery or left circumflex (LCX) occlusion. However, rare cases involving a wrap-around LAD can mimic an isolated inferior infarction pattern.

We report a 45-year-old man with acute chest pain and ST-segment elevation in inferior leads. Coronary angiography revealed a thrombotic mid-LAD lesion in a co-dominant system, with no right coronary or LCX artery involvement. Echocardiography showed inferior wall hypokinesia. The patient was managed conservatively with antithrombotic therapy, with complete thrombus resolution on follow-up angiography.

This case highlights a rare presentation of isolated inferior ST-elevation resulting from occlusion of a wrap-around LAD. Only four similar cases have been reported, and this is the only one successfully managed without stenting.

Awareness of coronary anatomical variants and dominance is crucial in accurately diagnosing myocardial infarction patterns.