Figure 5.

Case 5: Residual Pseudoaneurysm With Recurrent Ischemic Presentation

(A) Electrocardiogram at presentation showing new right bundle branch block with anterior Q waves, consistent with evolved anterior wall myocardial infarction. Coronary angiography in anteroposterior caudal and left anterior oblique caudal projections showing a small pseudoaneurysm involving the obtuse marginal stent; the black arrow in panel B indicates the pseudoaneurysm. Note chronic total occlusion/in-stent restenosis of the distal left anterior descending artery. (D) Strain imaging demonstrating reduced global longitudinal strain with marked anterior, anteroseptal, and anterolateral dysfunction. (E and F) Coronary computed tomography angiography showing the pseudoaneurysm involving the obtuse marginal stented segment without radiological evidence of ongoing infection; the black arrow in panel E indicates the pseudoaneurysm.