Author + information
- Received December 3, 2018
- Accepted December 11, 2018
- Published online April 15, 2019.
- Shahbaz A. Malik, MD and
- Andrew M. Goldsweig, MD∗ ()
- ↵∗Address for correspondence:
Dr. Andrew M. Goldsweig, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, Nebraska 68198.
- acute coronary syndrome
- chronic total occlusion
- collateral circulation
- left main disease
- non-ST-segment elevation myocardial infarction
A 59-year-old Hispanic man with no prior history of coronary artery disease was admitted with a non-ST-segment elevation myocardial infarction following several months of exertional chest pain. His electrocardiogram (Figure 1A) showed inferolateral ST-segment depression. He underwent coronary angiography, which revealed a chronic total occlusion of the left main coronary artery (Figure 1B). Given concern for circulatory collapse with right coronary artery contrast injection, mechanical circulatory support was initiated with an Impella device. Then, the right coronary artery was evaluated and found to be chronically occluded as well (Figure 1C). Collateral circulation connected the conus branch of the right coronary artery to the left anterior descending artery with retrograde filling of the left circumflex artery (Figure 1D). This conus collateral is known as Vieussens' arterial ring and is named after the seventeenth century anatomist Raymond de Vieussens. The collateral circulation proved critical because it permitted the patient to survive with bilateral coronary chronic total occlusions, a condition not typically compatible with life. The patient was treated with coronary bypass surgery.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 3, 2018.
- Accepted December 11, 2018.
- 2019 American College of Cardiology Foundation