Electrocardiographic change after recanalization in a patient with recent extensive anterior wall myocardial infarction

In a 66-year-old male with subacute extensive anterior wall myocardial infarction, we report a change in ST vector orientation from a basal anterior to a mid anterior after coronary artery recanalization of the proximal left anterior descending coronary artery with rotational atherectomy. The ST vector shift on the frontal plane after recanalization was consistent with a change toward more distal location of the ischemia on thallium-201 single photon emission computed tomography images compared to the findings during an exercise test before intervention. These findings may be correlated with local occlusion caused by distal microvascular embolization which was not visualized on coronary angiography following recanalization.