Reversible Perfusion Defects

Collateral Insufficiency

FINDINGS
IMPRESSION
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Impression:

  • Evidence of nontransmural inferior wall MI (5/25 segments) (arrows) and severe ischemia in the residual and adjacent myocardium (small lines) (RCA territory).

    Coronary angiography:

  • RCA - totally occluded, left to right collaterals
  • LAD - 50% proximal stenosis
  • LCX - 1st marginal branch - 70% stenosis
    -1st diagonal branch - 70-80% distal stenosis
  • Left ventricular ejection fraction = 57%

    Comments:
    Coronary angiography reveals a totally occluded RCA with left to right collaterals which is sufficient to keep the inferior wall well perfused at rest. During stress, however, the collateral perfusion to the inferior wall is insufficient, leading to ischemia, as noted in the stress study (collateral insufficiency).

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    Atlas of Myocardial Perfusion SPECT
    © Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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    Initiated: Nov 19, 1995. Last updated: April 26, 1999.