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A 45-year-old man presented with acute chest pain and inferior ST-segment elevation; coronary angiography identified a thrombotic mid-LAD lesion in a co-dominant system with no right coronary or left circumflex involvement. Echocardiography showed inferior wall hypokinesia. The patient received conservative antithrombotic management, achieving complete thrombus resolution on follow-up angiography and full recovery at one month. Highlights emphasize ECG variability and the diagnostic value of coronarography.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/isolated-inferior-myocardial-infarction-due-to-wrap-around-left-anterior-descending-artery-case-report/435598/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/isolated-inferior-myocardial-infarction-due-to-wrap-around-left-anterior-descending-artery-case-report/435598.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why did the patient show an isolated inferior ST-elevation pattern?","Question",{"text":112,"@type":113},"The wrap-around LAD supplied a significant portion of the inferior wall, so mid-LAD occlusion mimicked the ECG pattern usually associated with right coronary artery occlusion.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did coronary angiography reveal in this case?",{"text":117,"@type":113},"Coronary angiography showed a thrombotic mid-LAD lesion in a co-dominant system with no involvement of the right coronary artery or the left circumflex artery.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the patient treated and what was the outcome?",{"text":121,"@type":113},"Because stenting was refused and TIMI 3 flow was preserved, the patient was managed conservatively with antithrombotic therapy, resulting in complete thrombus resolution on follow-up angiography and full clinical recovery at one month.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435598,1790945260,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Case Report  \nIsolated inferior myocardial infarction due to wrap-around left anterior descending artery:  \ncase report  \nSelma Saidi, PhDa ,*, Nabil Laktib, PhDb , Mehdi Moujahid, PhDa , Aatif Benyass, PhDc , Zouhair Lakhal, PhDb  \nIntroduction and importance: Acute occlusion of the left anterior descending (LAD) artery usually produces ST-segment elevation in anterior electrocardiographic leads and reciprocal depression in inferior leads. Inferior ST-elevation is typically  \nassociated with right coronary artery or left circumflex (LCX) occlusion. However, rare cases involving a wrap-around LAD can mimic an isolated inferior infarction pattern.  \nCase presentation: We report a 45-year-old man with acute chest pain and ST-segment elevation in inferior leads. Coronary angiography revealed a thrombotic mid-LAD lesion in a co-dominant system, with no right coronary or LCX artery involvement. Echocardiography showed inferior wall hypokinesia. The patient was managed conservatively with antithrombotic therapy, with complete thrombus resolution on follow-up angiography.  \nClinical discussion: This case highlights a rare presentation of isolated inferior ST-elevation resulting from occlusion of a wraparound LAD. Only four similar cases have been reported, and this is the only one successfully managed without stenting. Conclusion: Awareness of coronary anatomical variants and dominance is crucial in accurately diagnosing myocardial infarction patterns.  \nKeywords: case report, coronary dominance, electrocardiogram, inferior ST-elevation, wrap-around left anterior descending  \nIntroduction  \nThe electrocardiogram (ECG) is critical in diagnosing acute myocardial infarction (AMI) and identifying the infarct-related artery[1,2] . Inferior ST-elevation typically suggests right coronary artery (RCA) or, less commonly, left circumflex (LCX) artery involvement. In contrast, left anterior descending (LAD) artery occlusion usually causes anterior ST-elevation. Our report describes one of the few cases of inferior ST-elevation myocardial infarction (STEMI) caused by a mid-LAD occlusion ina patient with a wrap-around LAD (Table 1) . This anatomical variation allowed LAD to supply a significant portion of the inferior wall, mimicking the ECG pattern of RCA occlusion.  \naCardiac Intensive Care Unit of the Cardiology Center, Mohammed V Military Teaching Hospital, Rabat, Morocco, bCath-Lab of the Cardiology Center, Mohammed VMilitary Teaching Hospital, Rabat, Morocco and cCardiology Center,  \nMohammed V Military Teaching Hospital, Rabat, Morocco  \nSelma SaidiandNabilLaktib contributed equally to this work and share first authorship. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Cardiac Intensive Care Unit of the Cardiology Center, Mohammed V Military Teaching Hospital, Rabat 10999, Morocco. [E-mail: saidi.selma45@gmail.com](E-mail: saidi.selma45@gmail.com) (S. Saidi).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons AttributionNon Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Annals of Medicine & Surgery (2026) 88:775–780  \nReceived 25 July 2025; Accepted 16 October 2025  \nPublished online 11 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004207](http://dx.doi.org/10.1097/MS9.0000000000004207)  \nHIGHLIGHTS  \n● We highlight the variability in ECG patterns of myocardial infarction (MI) based on coronary anatomy.  \n● We emphasize the role of coronarography in identifying the obstructed vessel and determining coronary dominance.  \n● Despite the typically poor prognosis of MI from wrapped left anterior descending thrombosis, our case was successfully manage","cbCaifqADh51ejJB","https://ap.wps.com/l/cbCaifqADh51ejJB","pdf",1293494,"English","# Introduction and importance\n# Case presentation\n## Initial ECG and clinical assessment\n## Coronary angiography and echocardiography\n# Clinical discussion\n# Conclusion\n# Highlights\n# Timeline","[{\"question\":\"Why did the patient show an isolated inferior ST-elevation pattern?\",\"answer\":\"The wrap-around LAD supplied a significant portion of the inferior wall, so mid-LAD occlusion mimicked the ECG pattern usually associated with right coronary artery occlusion.\"},{\"question\":\"What did coronary angiography reveal in this case?\",\"answer\":\"Coronary angiography showed a thrombotic mid-LAD lesion in a co-dominant system with no involvement of the right coronary artery or the left circumflex artery.\"},{\"question\":\"How was the patient treated and what was the outcome?\",\"answer\":\"Because stenting was refused and TIMI 3 flow was preserved, the patient was managed conservatively with antithrombotic therapy, resulting in complete thrombus resolution on follow-up angiography and full clinical recovery at one month.\"}]","Isolated inferior myocardial infarction due to wrap-around left anterior descending artery - case report | PDF",1790674355,15]