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Multiple Intimal Injuries Associated With Severe Coronary Spasm.

Koichiro Hori1, Riku Arai1, Keisuke Kojima1

  • 1Division of Cardiology, Department of Medicine Nihon University School of Medicine Tokyo Japan.

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|February 18, 2026
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Summary

Severe coronary vasospasm can cause cardiac arrest. Optical coherence tomography (OCT) identified intimal injuries and microthrombus, suggesting a high-risk phenotype needing aggressive management.

Keywords:
intimal injuryoptical coherence tomographysudden deathvasospasm

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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.