Adenosine-induced coronary vasospasm following drug-eluting stent implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Imaging

Background:

• Drug-eluting stents are commonly used to treat coronary artery disease.
• Adenosine stress myocardial perfusion single photon emission CT (SPECT) is a standard diagnostic tool.
• Coronary vasospasm is a potential complication of cardiac procedures and stress testing.

Observation:

• A patient with a history of drug-eluting stent implantation presented with chest pain.
• During adenosine stress SPECT, the patient experienced severe chest pain and ST elevation.
• Invasive coronary angiography revealed no in-stent restenosis.

Findings:

• The observed symptoms were attributed to adenosine-induced coronary vasospasm.
• This vasospasm occurred despite successful prior stent implantation.
• The findings suggest vasospasm as a cause of chest pain in stented arteries during stress.

Implications:

• Clinicians should consider coronary vasospasm in patients with prior stenting presenting with chest pain during adenosine stress.
• This case underscores the need for careful interpretation of stress test results in patients with coronary stents.
• Further research may be warranted to understand the mechanisms and management of vasospasm post-stenting.