Angioscopic differences of coronary intima between diffuse and focal coronary vasospasm: Comparison of optical coherence tomography findings

Kitano, Daisuke; Takayama, Tadateru; Sudo, Mitsumasa; Kogo, Takaaki; Kojima, Kensuke; Akutsu, Naotaka; Nishida, Toshihiko; Haruta, Hironori; Fukamachi, Daisuke; Kawano, Taro; Kanai, Takashi; Hiro, Takafumi; Saito, Satoshi; Hirayma, Atsushi

doi:10.1016/j.jjcc.2018.04.013

Cited by 18 publications

(30 citation statements)

References 51 publications

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“…This relationship was confirmed in autopsy case reports [26,27]. However, such plaque rupture has not been recognised in this and other studies [10][11][12][13][14]; thus, if present, this mechanism may be rare. Second, severe and repeating coronary spasms may lead to the repeating hypercontraction and extension of the intima, which results in coronary erosion.…”

Section: Discussionsupporting

confidence: 76%

“…Many studies have investigated the relationship between intracoronary thrombus formation and coronary spasm using intracoronary imaging techniques that show intracoronary thrombi in patients with VSA [ 10 , 11 , 12 , 13 , 14 ]. The frequency of intracoronary thrombus formation in patients with VSA might vary depending on the studied patients’ characteristics, such as the presence of ACS or MINOCA or chronic coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…The frequency of intracoronary thrombus formation in patients with VSA might vary depending on the studied patients’ characteristics, such as the presence of ACS or MINOCA or chronic coronary syndrome. Intracoronary imaging modalities include intravascular ultrasound (IVUS) [ 11 ], optical coherence tomography (OCT) [ 12 , 13 , 14 ] or coronary angioscopy (CAS) [ 10 , 14 ]. The assessment using IVUS or OCT could help determine the frequency of intracoronary thrombus formation in VSA patients, based on detailed observations of the entire circumference of the coronary artery and the whole of the coronary artery from the distal to proximal segments, especially in high-definition IVUS or OCT due to the high resolution of images.…”

Section: Introductionmentioning

confidence: 99%

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Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

et al. 2021

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Background: Despite significant interest in intracoronary thrombi in patients with vasospastic angina (VSA), the phenomenon remains unclarified. Therefore, we investigated a possible relationship using coronary angioscopy (CAS) in VSA patients. Methods: Sixty patients with VSA, for whom we could assess the spastic segment using CAS, were retrospectively studied. An intracoronary thrombus on CAS was a white thrombus and an erosion-like red thrombus. We verified the clinical characteristics and lesional characteristics as they determined the risk of intracoronary thrombus formation. Results: There were 18 (30%) patients with intracoronary thrombi. More of the patients with intracoronary thrombi were male, current smokers and had severe concomitant symptoms; however, no statistically significant difference was observed upon logistic regression analysis. There were 18 (26%) coronary arteries with intracoronary thrombi out of 70 coronary arteries recognised in the spastic segments. Furthermore, atherosclerotic changes and segmental spasms were significant factors responsible for such lesions. Conclusion: Intracoronary thrombi occurred in 30% of VSA patients and much attention should be paid to the intracoronary thrombogenicity of VSA patients.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

et al. 2021

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“…In previous research, Kitano et al demonstrated that yellow plaques containing lipids existed more frequently at the segments of focal CAS compared with the segments of diffuse CAS (Kitano et al, 2018). Given that focal CAS is caused by local hyperreactivity to a generalized constrictor stimulus in mild atherosclerosis, the researchers thought that the pathophysiology of diffuse CAS is limited to atherosclerotic lesions (Kitano et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Widespread ST‐segment elevation due to diffuse coronary artery spasm: A case report

Bai

Chen

Peng

2021

Noninvasive Electrocardiol

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Coronary artery spasm (CAS) is considered an important mechanism of acute coronary syndrome but not very common in the clinical setting. We report a case of a 42‐year‐old woman with chest pain lasting for 4 h due to diffuse CAS, which led to widespread ST‐segment elevation in multiple leads of the electrocardiogram and elevated cardiac troponin T. Emergency coronary angiography at admission showed significantly different morphological results from the second angiography during hospitalization, indicating the patient's discomfort was due to CAS rather than stenosis. Our case illustrates that diffuse CAS can cause widespread ST‐segment elevation and severe ACS.

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“…Coronary artery spasm shows various configurations such as focal spasm, diffuse spasm, or combined spasm and may lead to serious life-threatening arrhythmias in some patients [1]. As noninvasive tests, hyperventilation test and exercise test were performed in the clinic.…”

Section: Introductionmentioning

confidence: 99%

Clinical usefulness of myocardial scintigraphy in patients with vasospastic angina

Sueda

2020

Journal of Cardiology

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Background: Myocardial scintigraphy is defined as class IIb in the Japanese Circulation Society guideline for diagnosis of vasospastic angina (VSA). However, Caucasian guidelines had no classification of cardiac scintigraphy for diagnosis of VSA. Objectives: To clarify the clinical usefulness of myocardial scintigraphy, we analyzed the sensitivity and specificity of each cardiac scintigraphy. Methods: We extracted the 136 papers of myocardial scintigraphy from the PubMed database from 1980 to 2018 in patients with VSA. Finally we analyzed the 88 papers including 33 papers of 201thallium (Tl), 10 papers of 123 I beta-methyl 15-para-iodophenyl 3(R, S)-methylpentadecanoic acid (BMIPP), 9 papers of 123 I-metaiodobenzylguanidine (MIBG), 4 papers of 99m Tc-sestamibi (MIBI: methoxy-isobutylisonitrile), and 2 papers of tetrofosmin to investigate the sensitivity and specificity of each tracer. Results: Tl, BMIPP, or MIBG cardiac scintigraphy were useful to diagnose patients with VSA, because sensitivity was 57-73%. Specificity was 55-83%. Sensitivity of left circumflex artery was significantly lower than other vessels. BMIPP imaging may be helpful for clinical course of VSA. However, myocardial scintigraphic abnormal findings may not always show the ischemic memory due to coronary artery spasm. Conclusions: Recent cardiologists do not perform hyperventilation tests or MIBG scintigraphy for diagnosis of coronary spasm. After understanding the flow of the times, cardiologists should use Tl or BMIPP myocardial scintigraphy for VSA as one of supplementary tools in the real world.

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Angioscopic differences of coronary intima between diffuse and focal coronary vasospasm: Comparison of optical coherence tomography findings

Abstract: These results indicate that the presence of atherosclerotic plaques at the spasm site is likely to be related to the occurrence of a focal vasospasm. This may support the difference of features between focal CS and diffuse CS and contribute to precise treatment for each spasm type.

Cited by 18 publications

References 51 publications

Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

Widespread ST‐segment elevation due to diffuse coronary artery spasm: A case report

Clinical usefulness of myocardial scintigraphy in patients with vasospastic angina

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