Functional significance of the conus artery as a collateral to an occluded left anterior descending artery demonstrated by stress echocardiography

Abstract

Dobutamine stress echocardiography is a sensitive tool used for the detection of ischaemia. However, on occasion, there is a discrepancy between angiographic lesion severity and what would be expected from the abnormalities seen at stress echo. When stress echo underestimates severity it may be the case that collateral vessels play a significant role in preserving myocardial function. We present a case study where collateral flow in an occluded left anterior descending artery (LAD) is demonstrated as coming from the conus branch; and where stress echocardiography shows the relative preservation of function in the affected segments. Although rarely observed in clinical practice, the conus artery has occasionally been noted as a source of collateral blood flow. For the first time in the literature, this case demonstrates that the conus can provide functionally significant collateral blood supply to an occluded LAD.