PMC3072739_01
A) Right anterior oblique caudal view of left anterior descending artery. Total proximal occlusion of left anterior descending artery (white arrow). Arrowheads indicate mild ipsilateral collaterals from the obtuse marginal to the left anterior descending artery. B) Straight right anterior oblique view of right coronary artery. Contralateral collaterals from the right coronary artery are feeding the distal part of the left anterior descending artery (white arrow), giving the impression of a narrow and multi-atheromatous vessel. Arrowheads show severe and diffuse atheroma in the left anterior descending artery. (Image courtesy of the Catheterization Laboratory at Patras University Hospital).
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Beyond the proximal left anterior descending artery occlusion, the vessel was opacified through ipsilateral (Figure 1A) and mostly contralateral collaterals (Rentrop Grade 2), and appeared to have diffuse atheroma with at least three severe angiographic stenoses extending to its distal part (Figure 1B).
Right anterior oblique caudal (Panel A) and left anterior oblique; cranial (Panel B) projection of left anterior descending artery. After stent apposition, left anterior descending artery appears as a diffusely atheromatous vessel without critical stenosis. One more guide wire was used in order to protect the diagonal branch. (Image courtesy of the Catheterization Laboratory at Patras University Hospital).
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Surprisingly, following successful stenting of the proximal left anterior descending artery occlusion with a paclitaxel-eluting stent, it became evident that, distal to the latter, the vessel had diffuse atherosclerosis, but without any other significant angiographic stenosis as the initial angiography had suggested (Figure 2).