Prinzmetal's variant angina: clinical, angiographic and pathologic correlations in two typical cases

ECG and cinecoronary angiography of two patients with Prinzmetal's variant angina are reported. A pathologic study was performed on both. In one case, a transient luminal obstruction of the left circumflex coronary artery became apparent during selective coronary arteriography. Histologic examination of the corresponding coronary segment revealed a severe concentric atherosclerotic process with a normal-sized muscular layer, so that the angiographic transient occlusion might be attributed to an arterial spasm. In the second case no angiographic narrowings were demonstrated by cinecoronary angiography. Nevertheless, histologic examination revealed significant obstructive atherosclerotic narrowing in some coronary segments. It is suggested that atherosclerotic disease may be present also in cases with variant angina who have apparently normal coronary angiograms.