Delayed Anterior Interventricular Vein Opacification Guides True-Lumen Wiring in Stump-Less LAD Occlusion.
Qianfeng Xiong, Shaoyong Chen, Wenbo Li
✦ AI-curated · Sources linked
Case in brief
A 68-year-old woman presented with exertional chest pain and later developed ST-segment elevation during anterior STEMI. Emergency angiography revealed complete occlusion of the left anterior descending artery (LAD) without a clear proximal stump. Delayed opacification of the anterior interventricular vein (AIV) provided a fluoroscopic guide, allowing successful advancement of a guidewire into the distal LAD true lumen, followed by stenting and restoration of blood flow.
What made this case unusual
The case demonstrates the use of delayed AIV opacification as a fluoroscopic landmark in a stump-less LAD occlusion, which is not commonly reported.
Diagnostic / clinical pearl
Clinicians should consider delayed opacification of the anterior interventricular vein as a potential guide in complex cases of LAD occlusion during STEMI.
Why it matters
This case underscores the importance of utilizing anatomical landmarks in challenging coronary interventions, potentially improving outcomes in similar clinical scenarios.