A rare indication for stenting: persistent coronary artery spasm.
A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.
Ege University, medical School, Department of Cardiology, Izmir, Turkey.
H
H
Kültürsay
L
L
Can
S
S
Payzin
C
C
Türkoğlu
A
A
Altintiğ
M
M
Akin
A
A
Akilli
D000328:Adult; D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005080:Exercise Test; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D015607:Stents; D016277:Ventricular Function, Left / Q000502:physiology