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A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed severe systolic dysfunction involving the mid and apical segments (see online supplementary video 1). This was normal on the previous catheterisation.
Contributors All authors were involved in this particular case itself and have all participated in the preparation, writing and review of the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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