Successful Management of Intractable Coronary Spasm by a Coronary Stent

ABSTRACT

Variant angina is characterized by episodic angina due to spasm of an epicardial coronary artery at rest and concomitant transient ST elevation on electrocardiogram. While long-term survival of coronary spasm is usually excellent, but serious complications can be developed such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. We experienced 40 year-old man with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation and acute anterior myocardial infarction at the first admission. The patient underwent coronary angiogram, which revealed spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker. However, he complained of severe chest pain despite intensive medical therapy and visited emergency room 5 times during 8-month follow-up. We performed ergonovine coronary angiogram and intracoronary ultrasound, which revealed focal spasm at same site of proximal LAD with small amount of localized eccentric atheromatous plaque. Thus we placed coronary artery stent (3.0 x 24 mm GFX stent) at proximal LAD and his symptom was resolved after stenting. We performed follow-up coronary angiogram at 9 months after stenting and stent was patent without any stent recoil and in-stent restenosis.