Rare Plaque Rupture Within a Myocardial Bridge Presenting as Acute Anterior STEMI

BACKGROUND: A myocardial bridge (MB) is a congenital coronary anomaly in which a coronary artery tunnels through myocardium. Plaque formation and rupture typically occur proximal to the bridged segment. Rupture within an MB is rare and presents unique therapeutic challenges. CASE SUMMARY: A 61-year-old male smoker presented with refractory angina pectoris and anterior ST-segment elevations. Emergent percutaneous coronary intervention was pursued, and intravascular ultrasound confirmed plaque rupture within an MB. After balloon angioplasty, a 3.0 × 30 mm drug-eluting stent was deployed at high atmosphere, restoring TIMI flow grade 3 and providing necessary radial strength. DISCUSSION: This case is atypical, as rupture occurred at the distal portion of the bridge. While guidelines recommend conservative management given risk of stent fracture and restenosis, acute ST-segment elevation myocardial infarction with recurrent pain necessitated intervention. Intravascular ultrasound confirmed diagnosis and guided treatment. TAKE-HOME MESSAGE: Percutaneous coronary intervention can be safely performed in rare cases of MB plaque rupture when clinically imperative.