A 54-year-old man presented with a non-ST elevation myocardial infarction. Coronary angiography demonstrated a hazy appearance of the distal left main (LM) stem, and a thrombotic subtotal occlusion of the distal left anterior descending (LAD) artery with TIMI grade 1 flow (lower left panel, A, B). He was discharged following conservative management with antiplatelet treatment; however, he experienced ongoing exertional angina. Repeat angiography four weeks later demonstrated an ulcerated plaque in the distal LM stem, and a patent LAD with normal antegrade flow. There was …