title: Collateral myocardial blush in inferior wall myocardial infarction: a new diagnostic tool to differentiate between occluded right coronary and circumflex arteries.
abstract: OBJECTIVE
  The infarct-related artery (IRA) in inferior wall myocardial infarction (IMI) may be problematic to identify due to occasional instances in which the right coronary (RCA) and left circumflex (CX) arteries are both occluded. We sought to investigate if impaired collateral myocardial blush (CMBG) identifies the correct IRA.
  
  
  METHODS
  Between 2002 and 2010, we retrospectively analyzed 1907 patients who underwent primary angioplasty at our institution. Of these, 44 had an IMI together with total occlusion of both the RCA and CX.
  
  
  RESULTS
  Thirty of these had good collaterals to both distal vessels. Ten of this group had impaired CMBG, indicating the IRA. In 2 patients, angioplasty was attempted in the wrong artery in retrospect.
  
  
  CONCLUSIONS
  The correct IRA may be difficult to identify in patients with IMI and occlusion of both RCA and CX arteries. Impaired CMBG is a new tool to aid in this challenge.
authors.affiliation: Cardiology Department, Soroka University Medical Center, POB 151, Beer-Sheva, Israel. iliar@bgu.ac.il
authors.forename: Reuben
authors.initials: R
authors.lastname: Ilia
authors.forename: Arik
authors.initials: A
authors.lastname: Wolak
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Weinstein
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005456:Fluorescent Dyes; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000209:etiology / Q000628:therapy; D007267:Injections; D012189:Retrospective Studies
chemical_list: D005456:Fluorescent Dyes