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A 50-year-old Asian man presented to the emergency department with chest pain. On arrival he suffered a cardiac arrest with ventricular fibrillation from which he was successfully resuscitated. A post-resuscitation ECG showed right bundle branch block with inferior ST elevation, and he was immediately transferred for primary percutaneous coronary intervention. Right femoral arterial access was obtained and blood pressure was noted to be 140/30 mm Hg. Coronary angiography showed mild atherosclerosis in the left anterior descending and circumflex arteries. On attempted catheter intubation of the right coronary artery (figure 1A), contrast extravasation was noted (asterisk). An aortogram was conducted (figure 1B).
What is the most likely diagnosis?
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