Early recognition of catheter-induced left main coronary artery vasospasm: implications for revascularization.
Catheter-induced left main coronary artery (LMCA) vasospasm is a rare complication of coronary angiography that confounds the decision for coronary artery bypass graft (CABG) surgery. We report two cases of catheter-induced LMCA vasospasm. The first case was a 68-year-old woman who presented 6 years after CABG for presumed severe LMCA atherosclerotic disease. Coronary angiography demonstrated totally occluded CABGs and normal native coronary arteries, including a normal LMCA. The second case was a 56-year-old man with severe LMCA stenosis, who was scheduled for unprotected LM percutaneous coronary intervention (PCI). Repeat angiography 2 days later showed no stenosis. These cases emphasize the need for meticulous technique and a high index of suspicion of LMCA vasospasm. Intravascular ultrasound (IVUS) at the time of angiography may help to identify minimal atherosclerotic disease suggesting vasospasm. Alternatively, noninvasive testing, such as computed tomography (CT) angiography, may diagnose LM spasm in these patients prior to CABG surgery.
Edris
Ahmad
A
Division of Cardiology, Department of Medicine, University of California-Irvine Medical Center, 101 The City Drive South, Orange, CA 92868, USA.
Patel
Pranav M
PM
Kern
Morton J
MJ
D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000209:etiology*; D003951:Diagnostic Errors / Q000517:prevention & control*; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019564:Unnecessary Procedures; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents