Abstract

Diagnosis of a coronary occlusion in a patient with atypical chest pain

posted by Stephan Achenbach, M.D. | Jan 7, 2008

Case history
49-year-old patient with atypical chest pain and an equivocal bicycle stress test (non-significant ST segment depression in the anterior leads).

Question
The relative young age of the patient, atypical nature of the chest pain, and equivocal stress test make coronary artery disease rather unlikely. Thus, coronary CTA was performed to rule out the presence of coronary stenoses.

Diagnosis / Differential diagnosis
In patients with atypical chest pain, coronary CTA will often demonstrate normal coronary arteries. Here, however, a relatively long, chronic total occlusion of the proximal left anterior descending coronary artery was found. The lesion contained only very little calcium.

Findings
A chronic total occlusion of the proximal left anterior descending coronary artery (LAD) was detected. DSCT demonstrated that there was relatively little calcification present in the course of this occlusion, which facilitated the decision to perform an attempt at percutaneous interventional revascularization (PCI), which was successful.

Comment
DSCT can be useful in patients with atypical chest pain to rule out – or rule in – the presence of obstructive coronary artery lesions. In the context of CTO, lesion length and degree of calcification can be assessed by DSCT and may provide information on the probability of success of interventional revascularization.

[1] Long occlusion of the left anterior descending coronary artery seen in an 8-mm thick maximum intensity projection (arrows).	[2] Curved multiplanar reconstruction of the left anterior descending coronary artery. There is relatively little calcification in the course of the occlusion (arrows).
[3] Three-dimensional reconstruction of the heart and coronary arteries showing the occlusion of the LAD (arrows).	[4] Invasive coronary angiography confirms the LAD occlusion (arrows). Interventional recanalization is successful (insert). Cardiac: Coronary CT Angiography University of Erlangen-Nuremberg