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. 2022 Dec 19;2(2):100563. doi: 10.1016/j.jscai.2022.100563

Figure 1.

Figure 1

Multimodality assessment of a myocardial bridging segment. (A, B) Coronary angiography of a bridged segment (arrows) in the mid-LAD. (C) Coronary CTA showing intramyocardial course (arrow) of the mid LAD (preoperative). (D) Coronary CTA showing intramyocardial course (arrow) of the distal LAD (postoperative). (E) Coronary angiography of the mid-to-distal LAD without evidence of recurrent bridging. (F) iFR of the mid-to-distal LAD showing no ischemia at rest. (G-H) IVUS of the mid-to-distal LAD showing dynamic vessel compression (arrow) on 20.0 μg/kg/min of dobutamine. (I) iFR of the mid-to-distal LAD showing ischemia on dobutamine. (J) PCI of the mid-to-distal LAD with a 2.75 × 26.0-mm Resolute Onyx DES (Medtronic), postdilated to 3.0 mm proximally. (K-L) IVUS showing excellent stent apposition, expansion, and lack of dynamic vessel compression on 20.0 μg/kg/min of dobutamine. (M) iFR of the mid-to-distal LAD showing no further ischemia while on dobutamine. CTA, computed tomography angiogram; DES, drug-eluting stent; iFR, instantaneous wave-free ratio; IVUS, intravascular ultrasound; LAD, left anterior descending coronary artery; PCI, percutaneous coronary intervention.