Multiple Intimal Injuries Associated With Severe Coronary Spasm

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Coronary vasospasm is an underappreciated cause of out-of-hospital cardiac arrest.
• Intracoronary imaging features of severe vasospastic events remain undercharacterized.

Purpose of the Study:

• To characterize intracoronary imaging findings in a patient with recurrent cardiac arrest due to severe coronary vasospasm.

Main Methods:

• Case report of a patient with recurrent cardiac arrest.
• Intracoronary imaging using optical coherence tomography (OCT).

Main Results:

• OCT revealed focal intimal injuries, microthrombus, and vessel shrinkage.
• These findings occurred despite the absence of fixed coronary obstruction.
• The patient experienced repeated ischemic events, including fatal mesenteric ischemia.

Conclusions:

• Severe coronary vasospasm can cause repeated intimal injury and trigger fatal cardiac arrest.
• OCT may identify a high-risk vasospastic phenotype.
• Aggressive vasodilator-based management is indicated for this phenotype.