Catheter-induced Multiple Non-proximal Coronary Spasm in a Patient Presenting with Myocardial Infarction

Abstract

Interventional cardiologists encounter a wide range of lesions that cannot be angiographically distinguished from fixed atherosclerotic obstructive disease. In this case report, we document vasospasm at multiple sites in the coronary territory in a patient presenting with acute coronary syndrome. A 61-year-old woman was referred to our hospital with typical chest pain lasting approximately 1 h. After performing the left coronary artery angiography, a severe tubular stenosis was detected in circumflex (Cx) artery. Diffuse spasm was observed in the right coronary artery (RCA) and it resolved after intracoronary administration of nitroglycerin. After performing left system angiography again, severe stenosis in Cx artery was also completely resolved. Our finding is of clinical importance in that it is more likely to simulate a constant coronary stenosis than would have spasm occurred proximally. The clinical importance of our report is that a catheter-induced vasospasm (CIV) may simulate fixed coronary stenosis, not always osteally and in some instances at multiple sites. Awareness of this phenomenon and liberal use of nitroglycerin in any patient with discrete luminal narrowing, even when an ostial "lesion" is not present, can help to avoid misinterpreting CIV as an atherosclerotic lesion.

Intracoronary injection of nitroglycerine can prevent unnecessary percutaneous coronary intervention

“…Several case reports in the literature address the benefit of the administration of intracoronary nitroglycerine in patients who presented with ACS, and this action deferred them from PCI [ 22 – 25 ]. In a case series study by Vishnevsky et al [ 14 ], intracoronary nitroglycerine administration during angiography prior to a scheduled PCI resulted in the resolution of stenosis in all patients.…”

Left Main Coronary Artery Spasm: Case Report

“…Esenboga et al reported that in patients presenting with myocardial infarction (MI) catheter-induced multiple nonproximal coronary spasms. 4 Usually, atherosclerotic plaques develop at angulation and bifurcations due to shear stress; hence, ostial LMCA lesions are less frequent than mid and distal LM lesions. 5 If some irregularity is seen in the lesion, then atherosclerotic lesions may be more likely.…”