Successful management of intractable coronary spasm with a coronary stent.
Although the long-term survival of patients suffering from coronary spasm is usually excellent, serious complications can develop, such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an acute anterior myocardial infarction upon first admission. The patient underwent a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker, but continued to complain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period. An ergonovine coronary angiogram was performed and an intracoronary ultrasound examination, which revealed a focal spasm at the same site of the proximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms resolved. A follow-up coronary angiogram was performed 3 years after stenting and the stent remained patent without any in-stent restenosis or spasm.
Jeong
M H
MH
The Heart Center, Chonnam National University Hospital, The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea. myungho@chollian.net
Park
J C
JC
Rhew
J Y
JY
Kang
K T
KT
Lee
S H
SH
Cho
J H
JH
Kim
N H
NH
Kim
K H
KH
Ahn
Y K
YK
Bae
Y
Y
Cho
J G
JG
Park
J C
JC
Kim
S H
SH
Kang
J C
JC
D000328:Adult; D017311:Amlodipine / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003329:Coronary Vasospasm / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D004110:Diltiazem / Q000627:therapeutic use; D017292:Doxazosin / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004874:Ergonovine; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D020108:Nicorandil / Q000627:therapeutic use; D009566:Nitrates / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D015607:Stents; D013988:Ticlopidine / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000209:etiology
D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D009566:Nitrates; D011725:Pyridines; D017311:Amlodipine; D020108:Nicorandil; C038068:cicletanine; D004110:Diltiazem; D007548:Isosorbide Dinitrate; D017292:Doxazosin; D013988:Ticlopidine; D001241:Aspirin; D004874:Ergonovine