Coronary arterial spasm detected by coronary computed tomography angiography and confirmed by intravascular...

Area of Science:

• Cardiology
• Medical Imaging
• Vascular Biology

Background:

• Coronary artery disease diagnosis often relies on identifying atherosclerotic plaques.
• Coronary spastic angina can mimic symptoms of obstructive coronary artery disease.

Observation:

• A 40-year-old male presented with chest pain post-smoking.
• Coronary CT angiography indicated severe left anterior descending artery stenosis without visible plaque.
• Coronary angiography showed stenosis improvement after isosorbide dinitrate administration.

Findings:

• Intravascular ultrasound revealed negative remodeling and diffuse intima-media thickening, but no plaque at the stenosis site.
• These findings suggest coronary spastic angina as the cause of stenosis and chest pain.
• The patient was successfully treated with diltiazem hydrochloride.

Implications:

• This case highlights the importance of considering non-atherosclerotic causes of coronary artery stenosis.
• Advanced imaging techniques are crucial for differentiating plaque-related stenosis from vasospasm.
• Accurate diagnosis of coronary spastic angina can lead to appropriate medical management and symptom relief.