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Vasospastic total occlusion at the left main tract in a single coronary artery

Y Maejima1, T Yasu, N Fujiwara

  • 1Department of Integrated Medicine I, Omiya Medical Center, Jichi Medical School, Saitama, Japan.

Japanese Circulation Journal
|January 5, 2002
PubMed

Insights

A patient with a single coronary artery experienced left main coronary artery spasm, confirmed by acetylcholine infusion. This rare case highlights aberrant coronary artery spasm as a potential cause of sudden death in single coronary artery patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Anatomical Variations

Background:

  • Unstable angina pectoris is a critical condition requiring prompt diagnosis.
  • Single coronary artery is a rare congenital anomaly with varying clinical presentations.
  • Coronary artery spasm can cause myocardial ischemia even without fixed stenosis.

Observation:

  • A 64-year-old male presented with suspected unstable angina pectoris.
  • Coronary angiography revealed a single coronary artery originating from the right coronary artery (RCA) without significant fixed stenosis.
  • Superselective acetylcholine infusion into the left main coronary artery (LMCA) induced total occlusive spasm, chest pain, and ST-segment elevation.

Findings:

  • This is the first reported case of induced total LMCA occlusion via spasm in a patient with RCA-type single coronary artery.
  • Acetylcholine provocation effectively demonstrated vasospastic potential in the aberrant coronary artery.

Implications:

  • Aberrant coronary artery spasm is a potential, previously unrecognized mechanism for sudden cardiac death in individuals with single coronary artery.
  • This case underscores the importance of considering vasospasm in the diagnostic workup of patients with single coronary artery and ischemic symptoms.
  • Further research into the pathophysiology of coronary artery spasm in anomalous coronary arteries is warranted.

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