Symptomatic Reinfarction of a Previously Silent Myocardial Region Four Months After Successful Reperfusion

Abstract

Coronary collateral circulation helps to preserve myocardial perfusion distal to severely stenotic or totally obstructed coronary arteries. The presence or absence of angina pectoris and the state of myocardial function depend on the extent of collateralization and its functional contribution to myocardial blood flow. Clinical and experimental obser vations have suggested that newly developed collaterals usually remain even after successful revascularizaton. The authors present a case of a patient with extensive inter- coronary collaterals and hibernating myocardium after an acute inferior wall myocar dial infarction who underwent successful percutaneous transluminal coronary angio plasty of a totally obstructed, dominant right coronary artery and then experienced extensive reinfarction following reocclusion 4 months later. This case demonstrates failure of extensive collaterals to prevent acute myocardial infarction.