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Successful management of intractable coronary spasm with a coronary stent
M H Jeong1, J C Park, J Y Rhew
1The Heart Center, Chonnam National University Hospital, The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea. myungho@chollian.net
Insights
Coronary artery spasm can cause severe chest pain and heart attack. Stenting a blocked artery resolved symptoms in one patient, showing a viable treatment option for refractory cases.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Coronary artery spasm, while often associated with good long-term survival, can lead to severe complications including myocardial infarction and sudden cardiac death.
- Refractory coronary artery spasm presents a significant clinical challenge, often requiring intensive medical management.
Observation:
- A 40-year-old male experienced recurrent, intractable chest pain, ventricular fibrillation, and acute anterior myocardial infarction due to focal coronary artery spasm in the proximal left anterior descending artery (LAD).
- Despite maximal medical therapy with nitrates and calcium channel blockers, the patient had frequent emergency room visits, indicating treatment failure.
Findings:
- Intracoronary ultrasound revealed a focal spasm at the proximal LAD with a small eccentric atheromatous plaque.
- Percutaneous coronary intervention with stent placement in the proximal LAD successfully resolved the patient's symptoms.
Implications:
- Coronary artery stenting can be an effective treatment for patients with severe, refractory coronary artery spasm unresponsive to medical therapy.
- Long-term follow-up demonstrated sustained patency of the stent without restenosis or recurrent spasm, supporting its durability.
Abstract:
Although the long-term survival of patients suffering from coronary spasm is usually excellent, serious complications can develop, such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an acute anterior myocardial infarction upon first admission. The patient underwent a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker, but continued to complain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period. An ergonovine coronary angiogram was performed and an intracoronary ultrasound examination, which revealed a focal spasm at the same site of the proximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms resolved. A follow-up coronary angiogram was performed 3 years after stenting and the stent remained patent without any in-stent restenosis or spasm.