PTCA of complex atherosclerotic lesion at site of LAD myocardial bridging
H M Cohen1, J Juska, J H Kleiman
1Saint Joseph Hospital and Health Care Center, Chicago, Illinois, USA.
Insights
Balloon angioplasty successfully treated a critical atherosclerotic lesion within left anterior descending myocardial bridging in an elderly patient. This case highlights a rare but effective treatment for refractory angina pectoris.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Atherosclerotic lesions in myocardial bridging can cause refractory angina pectoris.
- Myocardial bridging is a congenital anomaly where a segment of coronary artery lies embedded within the myocardium.
- Complex atherosclerotic lesions at the distal extent of myocardial bridging pose unique therapeutic challenges.
Observation:
- An 86-year-old patient with prior angina and stroke presented with acute myocardial infarction and concurrent nonhemorrhagic stroke.
- Medical therapy for post-myocardial infarction angina was ineffective.
- Coronary angiography revealed a complex, critical atherosclerotic lesion at the distal end of a long left anterior descending (LAD) myocardial bridge.
Findings:
- The "culprit" lesion was successfully treated with balloon angioplasty.
- This represents the second reported case of successful balloon angioplasty for atherosclerotic lesions within LAD myocardial bridging.
- The patient's refractory angina was resolved following the intervention.
Implications:
- Balloon angioplasty is a viable revascularization strategy for complex atherosclerotic lesions in myocardial bridging.
- This approach may offer an alternative to surgical intervention in select patients.
- Further research is warranted to understand the long-term efficacy and safety of this treatment modality.
Abstract:
An 86-year-old patient with a history of chronic angina pectoris and a remote cerebrovascular accident presented to the hospital with an acute myocardial infarction complicated by a concomitant nonhemorrhagic cerebrovascular accident. Postmyocardial infarction angina pectoris, refractory to maximal medical therapy, led to coronary angiography. This demonstrated the "culprit" lesion to be a complex and critical atherosclerotic lesion at the distal-most extent of a long area of left anterior descending (LAD) myocardial bridging. This "culprit" lesion was successfully treated by balloon angioplasty. This is the second report in the recent literature of balloon angioplasty revascularization used in this fashion. Similarities and differences between our case report and the prior report in the literature are compared and contrasted.
