Rare Plaque Rupture Within a Myocardial Bridge Presenting as Acute Anterior STEMI

A myocardial bridge (MB) is a congenital coronary anomaly in which a coronary artery tunnels through myocardium. Plaque formation and rupture typically occur proximal to the bridged segment. Rupture within an MB is rare and presents unique therapeutic challenges.

A 61-year-old male smoker presented with refractory angina pectoris and anterior ST-segment elevations. Emergent percutaneous coronary intervention was pursued, and intravascular ultrasound confirmed plaque rupture within an MB. After balloon angioplasty, a 3.0 × 30 mm drug-eluting stent was deployed at high atmosphere, restoring TIMI flow grade 3 and providing necessary radial strength.

This case is atypical, as rupture occurred at the distal portion of the bridge. While guidelines recommend conservative management given risk of stent fracture and restenosis, acute ST-segment elevation myocardial infarction with recurrent pain necessitated intervention. Intravascular ultrasound confirmed diagnosis and guided treatment.

Percutaneous coronary intervention can be safely performed in rare cases of MB plaque rupture when clinically imperative.