Multivessel coronary artery disease: atheroma progression and dynamic component

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Multivessel or multisegment coronary artery spasm is infrequent in patients with widespread coronary atherosclerotic disease.
• A case of prolonged spasm affecting both the left main and left anterior descending arteries is presented in a patient with chronic effort angina and multivessel coronary artery disease.

Observation:

• The patient experienced angina and palpitations, primarily at rest.
• Coronary angiography revealed significant stenoses in the left main, left anterior descending, and posterior descending arteries, with no in-stent restenosis.
• Intracoronary nitrates resolved left main and left anterior descending artery stenoses, but not the posterior descending artery stenosis.

Findings:

• Selective coronary artery spasm involving multiple, distinct arterial segments is a rare clinical occurrence.
• Left main coronary artery spasm is critical due to its potential to be misdiagnosed and lead to unnecessary coronary artery bypass grafting.
• Intracoronary nitrates demonstrated efficacy in resolving spasm in specific coronary segments, highlighting their diagnostic and therapeutic utility.

Implications:

• Early administration of intracoronary nitrates should be considered in cases of suspected coronary artery spasm before pursuing invasive interventions.
• Accurate diagnosis of coronary artery spasm can prevent unnecessary surgical interventions like coronary artery bypass grafting.
• Understanding selective spasm patterns aids in refining treatment strategies for complex coronary artery disease.