Significant coronary stenosis in a patient with normal perfusion

A 58-year-old man with type 2 diabetes and hypertension who was a smoker presented to the outpatient clinic with atypical symptoms. A 64-slice multislice computed tomography scan showed only minor wall irregularities in the right coronary artery and left anterior descending coronary artery. Borderline significant stenosis in the proximal left circumflex coronary artery was detected, however. The left main, left anterior descending, and left circumflex coronary arteries are shown in the Figure. Panel A shows a 3-dimensional volume-rendered reconstruction, and Panel B shows an enlargement of Panel A, revealing the significant stenosis (arrow). The curved multiplanar reconstruction (Panel C) confirmed the presence of a significant lesion. Subsequently, myocardial perfusion imaging was performed, which showed normal perfusion (Panel D). Accordingly, the patient was not referred for conventional coronary angiography, but medical therapy was started in combination with aggressive risk factor modification.

The left main (LM), left anterior (LAD), and left circumflex coronary arteries (LCx) are shown: (A) 3-dimensional volume-rendered reconstruction; (B) enlargement of Panel A, with arrow indicating significant stenosis; (C) curved multiplanar reconstruction confirmed the presence of a significant lesion (arrow); and (D) normal perfusion is shown in the stress images (top panel) and resting images (lower panel).

Figure.