Successful primary percutaneous coronary interventions in a patient with two consecutive ST-segment elevation myocardial infarctions and dual left anterior descending artery (type IV)

Marijan Spasić; Boris Džudović; Siniša Rusović; Zoran Jović; Predrag Djurić; Radoslav Romanović; Nemanja Djenić; Radomir Matunović; Slobodan Obradović

doi:10.2298/7016

Marijan Spasić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Boris Džudović Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
Zoran Jović Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Predrag Djurić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
Radoslav Romanović Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
Nemanja Djenić Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
Radomir Matunović Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
Slobodan Obradović Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/7016

Keywords: coronary vessels, congenital abnormalities, myocardial infarction, stents, reoperation, electrocardiography,

Abstract

Introduction. Dual left anterior descending (LAD) artery is a very rare inherited anomaly. It can be incidentally revealed during primary percutaneous coronary intervention (pPCI) and may produce difficulties in detecting and treating the culprit lesion. Case report. We presented a 52-year-old male patient with ST-segment elevation myocardial infarction (STEMI) of inferior wall, in whom dual LAD anomaly was revealed during pPCI: a short LAD artery originated from the left main coronary artery and a long LAD artery originated from the proximal part of the right coronary artery (RCA). A bare metal stent was successfully implanted in the place of the culprit lesion in RCA and ST-segment resolution was achieved in ECG. After two hours, the patient was referred again to the catheter lab due to new STEMI of anteroseptal wall. Another bare metal stent was implanted in new infarction related artery, this time it was proximal part of the short LAD. Conclusion. Careful and correct interpretation of ECG is very helpful in detection and treatment of the culprit lesion in cases with dual LAD.

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