Intractable Coronary Spasm Requiring Percutaneous Coronary Intervention after Coronary Artery Bypass Grafting in a...

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Moyamoya disease (MMD) involves progressive stenosis of major cerebral arteries, leading to cerebrovascular events.
• Extracranial manifestations of MMD, including coronary artery issues like variant angina and myocardial infarction, are documented.
• However, myocardial infarction following coronary artery bypass grafting (CABG) in MMD patients has not been previously reported.

Observation:

• This report details a patient with Moyamoya disease who experienced cardiac arrest due to myocardial infarction.
• The event occurred secondary to coronary artery spasm after undergoing off-pump CABG.
• The patient required veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous coronary intervention (PCI) for management.

Findings:

• Myocardial infarction caused by coronary spasm is a potential complication in MMD patients undergoing CABG.
• Successful management of this rare complication is achievable with advanced interventions like VA-ECMO and PCI.
• This case underscores the importance of considering coronary artery spasm in MMD patients presenting with cardiac events post-CABG.

Implications:

• This case highlights a previously undescribed complication of Moyamoya disease in the context of cardiac surgery.
• It emphasizes the need for heightened vigilance regarding coronary artery spasm in MMD patients, especially those with a history of CABG.
• The successful outcome suggests that aggressive management strategies, including VA-ECMO and PCI, can be effective in treating this rare but life-threatening condition.