Abstract
Coronary collateral arteries are alternative conduits for blood flow in obstructive coronary heart disease (CAD). Collateral circulation is important in preserving ventricular function in coronary artery disease with total occlusion. Still, during exercise these collaterals are often limited in their functional reserve. This case demonstrates unusual presentation of stress echocardiography (SEcho) and coronary flow reserve (CFR) in the patient after primary percutaneous coronary intervention (pPCI). Due to the limited area of myocardial ischemia provoked with exercise and retrograde coronary flow with the value of CFR correspondent to excellent collaterals, the patient was left on medical therapy, even thou the repeated coronary angiography showed complete in-stent occlusion of the proximal to middle LAD with well-developed collaterals.
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