title: Coronary artery multistenting in the treatment of life-threatening refractory coronary spasm after coronary artery bypass grafting.
abstract: A 74-year-old man had undergone on-pump coronary artery bypass grafting (CABG) for effort-induced angina pectoris. Soon after CABG using the left internal thoracic artery for the left anterior descending artery and saphenous vein for the left circumflex artery, ST elevation was found in the inferior leads and complete atrioventricular block, ventricular tachycardia, and circulatory collapse occurred. Emergent coronary angiography revealed diffuse severe spasm of the right coronary artery (RCA). Despite the intravenous and intracoronary administration of massive doses of vasodilators and intra-aortic balloon pumping, the coronary spasm did not resolve. Five stents were deployed from the distal to the proximal portion of the RCA. After multistenting, coronary flow was dramatically improved and the ST elevations in the inferior leads were also improved. Coronary artery spasm after CABG is relatively rare, but when it occurs, it can be fatal. Multistenting is a useful treatment for life-threatening refractory coronary spasm after CABG.
authors.affiliation: Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Toyama.
authors.forename: Bunji
authors.initials: B
authors.lastname: Kaku
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ikeda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kato
authors.forename: Shu
authors.initials: S
authors.lastname: Takabatake
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Tomio
authors.initials: T
authors.lastname: Taguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Niita
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hiraiwa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Aoki
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents