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Systolic compression of the left anterior descending coronary artery: A case series, review of the literature, and therapeutic options including stenting
Author(s) -
Berry John F.,
von Mering Greg O.,
Schmalfuss Carsten,
Hill James A.,
Kerensky Richard A.
Publication year - 2002
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10151
Subject(s) - medicine , myocardial bridge , fractional flow reserve , cardiology , chest pain , myocardial infarction , radiology , cath lab , vasospasm , stenosis , ischemia , stent , coronary angiography , conventional pci , subarachnoid hemorrhage
Six cases in our institution of various presentations of left anterior descending (LAD) myocardial bridging were found on coronary angiography. Generally a benign condition, this finding can result in ischemia or infarction as seen in some of our cases. We found one case in which the bridge resulted in an anterior myocardial infarction in an elderly patient, one case with fixed stenoses at the entry and exit point of the bridge causing ischemia, another with vasospasm within the bridged segment, one case in which the patient was referred for intervention of a fixed stenosis which after intracoronary nitroglycerin (NTG) was found to be an LAD bridge, another case in which the thallium myocardial perfusion scan revealed a reversible anterior defect, and finally one case with anginal chest pain despite a normal coronary flow reserve proximal and distal to the bridged segment. Our treatments varied from stenting in three patients to medical therapy in the remaining patients. We concluded that a thorough evaluation in this population should include functional testing for ischemia, intravascular ultrasound to assess wall thickness, and coronary flow reserve measurements in order to determine the significance of the these bridges. Stenting may have a role in select patients. However, additional studies are needed. Cathet Cardiovasc Intervent 2002;56:58–63. © 2002 Wiley‐Liss, Inc.