594 Indian Heart J 2008; 60: 594–596 Myocardial Bridge in Association with Fixed Atherosclerotic Lesions Treated with Drug-eluting Stents: A Follow-up Report with Quantitative Coronary Analysis Parneesh Arora, Vineet Bhatia, Ashok Kumar Parida, Upendra Kaul Department of Cardiology, Fortis Hospital, NOIDA (UP) Case Report Correspondence: Prof. Upendra Kaul, Director & HOD, Department of Cardiology, Fortis Hospital, B-22, Sector-62, NOIDA (UP). E-mail: ukaul@vsnl.com; upendra.kaul@fortishealthcare.com INTRODUCTION Myocardial bridge is one of the most common congeni- tal coronary anomalies with an incidence of 0.5–2.5% as assessed on coronary angiography 1 and is defined as a seg- ment of major epicardial coronary artery that goes intra- murally through the myocardium. Association of coronary stenosis with myocardial bridge though infrequent has been described in literature and is usually located proximal to the muscle bridge. 2 Stenting of muscle bridge is a controversial issue because of high restenosis rates, fear of stent compres- sion and fractures. We report our experience with a case of coronary stenosis distal to a muscle bridge. CASE REPORT A 65-year-old male, known hypertensive presented with dyspnea and angina on exertion class II and a positive stress test. ECG was consistent with left ventricular hypertrophy. Echo done revealed mild concentric left ventricular hyper- trophy (LVH) and normal LV function. Baseline biochemis- try and hematological investigations were normal. Coronary angiography was done which revealed significant double- vessel disease right coronary artery (RCA) distal 99%, left anterior descending (LAD) mid 90% tubular stenosis (type B) with a proximal muscle bridge causing <50% systolic compression (Figure 1) and LCX distal 50%. Double-vessel angioplasty for RCA and LAD was planned. A 3.0 × 16 mm DES (YUKON ® choice non-polymer-based rapamycin-elut- ing stent, Translumina Gmbh, Germany) was implanted in ABSTRACT Stenting of muscle bridge is still a controversial issue with concerns regarding high restenosis rates, plaque prolapse and stent fracture. We report a case with significant atherosclerotic disease of right coronary artery and left anterior descending artery associated with a muscle bridge, proximal to the diseased segment which became more prominent after stenting the fixed lesion. This was managed by implanting another drug eluting stent, covering the bridge. Angiographic follow-up at 9 months revealed no difference in quantitative coronary angiography parameters in the stented segment of the bridge, as compared to other stented segments. KEYWORDS Myocardial bridge, coronary stenting, quantitative coronary angiography Figure 1. AP cranial view showing native LAD stenosis - diastolic frame. JNL-321.indd 594 JNL-321.indd 594 1/16/2009 6:17:30 PM 1/16/2009 6:17:30 PM