[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-432351-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-432351-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","wrap-around-left-anterior-descending-coronary-artery-occlusion-presenting-with-the-de-winter-pattern-and-inferior-st-segment-elevation-myocardial-infarction-stemi-a-case-report-and-comprehensive-literature-review","Wrap-Around Left Anterior Descending Coronary Artery Occlusion Presenting With the de Winter Pattern and Inferior ST-Segment Elevation Myocardial Infarction (STEMI) - A Case Report and Comprehensive Literature Review","","The left anterior descending (LAD) coronary artery can present a “wrap-around” anatomical variant in which the distal vessel continues beyond the left ventricular apex to supply the inferior wall. Acute occlusion may produce simultaneous anterior and inferior electrocardiographic changes, including ST-segment elevation with a de Winter pattern. A patient in his 60s with recurrent myocardial infarction developed inferior STEMI and an anterior de Winter pattern, confirmed by coronary angiography and treated with angioplasty. Despite timely revascularization, ischemic HFmrEF developed, emphasizing the need for rapid ECG recognition to limit damage and prevent death.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/wrap-around-left-anterior-descending-coronary-artery-occlusion-presenting-with-the-de-winter-pattern-and-inferior-st-segment-elevation-myocardial-infarction-stemi-a-case-report-and-comprehensive-literature-review/432351/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/wrap-around-left-anterior-descending-coronary-artery-occlusion-presenting-with-the-de-winter-pattern-and-inferior-st-segment-elevation-myocardial-infarction-stemi-a-case-report-and-comprehensive-literature-review/432351.png","ImageObject",300,407,{"name":42,"@type":43},"Marglet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the “wrap-around” LAD and why does it matter clinically?","Question",{"text":63,"@type":64},"A wrap-around LAD is an anatomical variant where the distal LAD continues beyond the left ventricular apex and supplies part of the inferior wall. Its occlusion can cause characteristic ECG patterns that can obscure the culprit artery and delay treatment.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which ECG findings were key in this case?",{"text":68,"@type":64},"The ECG showed inferior ST-segment elevation myocardial infarction (STEMI) together with an anterior de Winter pattern. The de Winter pattern included J-point upsloping ST-segment depression that continued into tall, symmetrical T-waves, suggesting proximal LAD occlusion or severe obstruction.",{"name":70,"@type":61,"acceptedAnswer":71},"How was the patient treated and what outcome occurred afterward?",{"text":72,"@type":64},"Coronary angiography revealed proximal and distal subocclusions of the wrap-around LAD, treated successfully with angioplasty. Despite an optimal first medical contact-to-balloon time and a good angiographic result, the patient later developed ischemic heart failure with mildly reduced ejection fraction (HFmrEF).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},432351,1790736482,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":116,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 11/07/2025  \nReview ended 12/01/2025  \nPublished 12/04/2025  \n© Copyright 2025  \nGranata et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98496  \nOpen Access Case Report  \nWrap-Around Left Anterior Descending Coronary Artery Occlusion Presenting With the de Winter Pattern and Inferior ST-Segment Elevation Myocardial Infarction (STEMI): A Case Report and Comprehensive Literature Review  \nLucio Giuseppe Granata 1 , Francesco Amico 1, Marcello Marchetta 2, Francesca Campanella 1, Simona Giubilato 1  \n1. Cardiology, Cannizzaro Hospital, Catania, ITA 2. Cardiology, Policlinico Tor Vergata, Rome, ITA Corresponding author: Lucio Giuseppe Granata, [lucio.granata87@gmail.com](lucio.granata87@gmail.com)  \nAbstract  \nThe left anterior descending (LAD) coronary artery originates from the left main coronary artery and runs along the interventricular groove, terminating before the apex of the left ventricle. A “wrap-around” LAD is a normal anatomical variant in which the distal portion of the vessel continues beyond the apex to supply part of the inferior wall. Its acute occlusion can frequently produce characteristic electrocardiographic changes, with ST-segment elevation in both the anterior and inferior leads. These diffuse repolarization abnormalities can make it difficult to identify the culprit artery and may even be mistaken for non-ischemic alterations, thus delaying appropriate treatment.  \nWe report a case of wrap-around LAD occlusion presenting with unusual and distinctive ECG findings. Aman in his 60s with multiple cardiovascular risk factors and recurrent myocardial infarction presented with acute chest pain. The ECG showed ST-segment elevation myocardial infarction (STEMI) in the inferior leads, associated with a de Winter pattern in the anterior leads, characterized by 1-3 mm upsloping ST-segment depression at the J point that continued into tall, symmetrical T-waves, indicative of proximal LAD occlusion or severe obstruction. Coronary angiography revealed both proximal and distal subocclusions of a wrap-around LAD, successfully treated with angioplasty without procedural complications; However, despite the good angiographic result and an optimal first medical contact-to-balloon time, the patient subsequently developed an infarction-related complication, manifesting as ischemic heart failure with mildly reduced ejection fraction (HFmrEF) .  \nThis case represents a unique demonstration of how this LAD variant can produce the simultaneous coexistence of a de Winter pattern and inferior ST-segment elevation. Although rare, the ECG signs of wraparound LAD occlusion are distinctive and must be promptly recognized, as immediate reperfusion is indicated to prevent poor prognosis, extensive myocardial damage, heart failure, and death. In our case, despite early and successful revascularization, the patient developed ischemic HFmrEF, underscoring the severity of the consequences associated with wrap-around LAD occlusion and highlighting the potentially serious damage that may result from delayed or missed diagnosis.  \nCategories: Cardiology  \nKeywords: acute coronary syndrome, coronary angiography, de winter pattern, electrocardiography, heart failure  \nwith reduced ejection fraction, myocardial infarction, percutaneous coronary intervention, stemi, st-segment  \nelevation, wrap-around left anterior descending artery  \nIntroduction  \nThe left anterior descending (LAD) coronary artery is typically 10-13 cm long, originates from the left main coronary artery, and courses through the interventricular groove, usually terminating before reaching the apex of the left ventricle. Along its course, it gives rise to septal perforators and diagonal branches that supply the anterior and anterolateral walls o","cbCaiuVQEP74cv33","https://ap.wps.com/l/cbCaiuVQEP74cv33","pdf",4033949,"English","# Abstract\n## Case Report\n## Coronary Anatomy and ECG Rationale\n## ECG Variants of LAD","[{\"question\":\"What is the “wrap-around” LAD and why does it matter clinically?\",\"answer\":\"A wrap-around LAD is an anatomical variant where the distal LAD continues beyond the left ventricular apex and supplies part of the inferior wall. Its occlusion can cause characteristic ECG patterns that can obscure the culprit artery and delay treatment.\"},{\"question\":\"Which ECG findings were key in this case?\",\"answer\":\"The ECG showed inferior ST-segment elevation myocardial infarction (STEMI) together with an anterior de Winter pattern. The de Winter pattern included J-point upsloping ST-segment depression that continued into tall, symmetrical T-waves, suggesting proximal LAD occlusion or severe obstruction.\"},{\"question\":\"How was the patient treated and what outcome occurred afterward?\",\"answer\":\"Coronary angiography revealed proximal and distal subocclusions of the wrap-around LAD, treated successfully with angioplasty. Despite an optimal first medical contact-to-balloon time and a good angiographic result, the patient later developed ischemic heart failure with mildly reduced ejection fraction (HFmrEF).\"}]","Wrap-Around Left Anterior Descending Coronary Artery Occlusion Presenting With the de Winter Pattern and Inferior ST-Segment Elevation Myocardial Infarction (STEMI) - A Case Report and Comprehensive Literature Review | PDF",1790659279,23]