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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging

Masaki Kodaira1, Ryota Tabei1, Toshiki Kuno1

  • 1Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan.

BMJ Case Reports
|December 10, 2017
PubMed

Insights

This case highlights how intravascular ultrasound (IVUS) diagnosed catheter-induced coronary vasospasm during angiography for stable angina. Prompt treatment with isosorbide dinitrate restored coronary blood flow.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Coronary angiography is a standard procedure for diagnosing stable angina.
  • Complications during angiography, though rare, require accurate diagnosis and management.
  • Coronary vasospasm can mimic other cardiac events.

Observation:

  • A 46-year-old male patient developed an inferior ST-segment myocardial infarction during coronary angiography.
  • Intravascular ultrasound (IVUS) imaging was performed to investigate the cause of the myocardial infarction.
  • IVUS revealed findings consistent with coronary vasospasm.

Findings:

  • The observed ST-segment myocardial infarction was attributed to catheter-induced coronary vasospasm.
  • Intracoronary administration of isosorbide dinitrate effectively resolved the vasospasm and restored coronary blood flow.
  • IVUS imaging was crucial in differentiating vasospasm from other potential causes of myocardial infarction.

Implications:

  • This case underscores the diagnostic utility of IVUS in identifying catheter-induced coronary vasospasm during interventional procedures.
  • Early and accurate diagnosis of coronary vasospasm can prevent further cardiac damage and guide appropriate treatment.
  • The findings emphasize the importance of considering vasospasm as a complication of coronary angiography and the effectiveness of medical management.

Keywords:
clinical diagnostic testsischaemic heart disease

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