Isolated inferior myocardial infarction due to wrap-around left anterior descending artery: case report

Abstract

Introduction and importance: Acute occlusion of the left anterior descending (LAD) artery usually produces ST-segment elevation in anterior electrocardiographic leads and reciprocal depression in inferior leads. Inferior ST-elevation is typically associated with right coronary artery or left circumflex (LCX) occlusion. However, rare cases involving a wrap-around LAD can mimic an isolated inferior infarction pattern. Case presentation: We report a 45-year-old man with acute chest pain and ST-segment elevation in inferior leads. Coronary angiography revealed a thrombotic mid-LAD lesion in a co-dominant system, with no right coronary or LCX artery involvement. Echocardiography showed inferior wall hypokinesia. The patient was managed conservatively with antithrombotic therapy, with complete thrombus resolution on follow-up angiography. Clinical discussion: This case highlights a rare presentation of isolated inferior ST-elevation resulting from occlusion of a wrap-around LAD. Only four similar cases have been reported, and this is the only one successfully managed without stenting. Conclusion: Awareness of coronary anatomical variants and dominance is crucial in accurately diagnosing myocardial infarction patterns.