title: Clinical outcome of coronary stenting in patients with variant angina refractory to medical treatment: a consecutive single-center analysis.
abstract: OBJECTIVE
  To investigate the efficacy of coronary stenting in patients with variant angina refractory to medical treatment.
  
  
  METHODS
  Variant angina was diagnosed in 81 patients admitted to the Department of Cardiology between January 2003 and June 2011. However, coronary stenting was performed in 21 patients refractory to medical treatment, but coronary angiography and intravascular ultrasound were performed in all patients, and acetylcholine provocative test was performed in 11 of the 21 patients refractory to medical treatment. Coronary angiography was repeated after 9-12 months in the 21 patients with coronary stents. Clinical follow-up time was 2.5 ± 3.1 years (range 1-8).
  
  
  RESULTS
  Of the 81 patients, coronary angiography and intravascular ultrasound did not reveal significant stenosis in 13 (16.0%), but revealed 20-75% fixed stenosis in the remaining 68 (84.0%) patients. The acetylcholine provocative test was positive in the 11 patients. Of the 21 patients with coronary stents, the spasm site was located in the right coronary artery in 16 (76.2%) and in the left anterior descending artery in the remaining 5 (23.8%) patients. During the 1- to 8-year follow-up period, 1 of the 21 patients with stents developed recurrent episodes of variant angina, 5 patients had occasional chest pain, and the other 15 were asymptomatic. Coronary angiography at 9-12 months after initial evaluation demonstrated no stenosis in 3 patients, 20-40% in-stent mild intimal hyperplasia in 15 patients, and 50-80% in-stent restenosis in 3 patients. Coronary stenting was performed again in 2 patients.
  
  
  CONCLUSIONS
  The present study showed that coronary stenting for severe refractory coronary vasospasm was effective and without serious complications. It can be an alternative and viable option for some patients who are refractory to medical therapy and at a high risk of acute coronary syndrome recurrence.
authors.affiliation: Department of Cardiovascular Medicine, First People's Hospital, Shanghai Jiaotong University, Shanghai, PR China.
authors.forename: Guang
authors.initials: G
authors.lastname: Chu
authors.forename: Guobing
authors.initials: G
authors.lastname: Zhang
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Shaowen
authors.initials: S
authors.lastname: Liu
authors.forename: Qinzhu
authors.initials: Q
authors.lastname: Wen
authors.forename: Baogui
authors.initials: B
authors.lastname: Sun
mesh_terms: D000368:Aged; D000788:Angina Pectoris, Variant / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome