Intravascular ultrasound detection of atherosclerosis at the site of focal vasospasm in angiographically normal or minimally narrowed coronary segments

Yamagishi, Masakazu; Miyatake, Kunio; Tamai, Jun; Nakatani, Satoshi; Koyama, Jun; Nissen, Steven E.

doi:10.1016/0735-1097(94)90419-7

Cited by 209 publications

(97 citation statements)

References 19 publications

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“…The characteristics of the lesion that is the culprit of coronary spasm are the existence of minimal atherosclerosis, with relatively low-echo intensity, less calcification, and negative remodeling on IVUS images. [6][7][8][9][10] In our case, the IVUS image at the occlusion site shared some of the above previously reported IVUS characteristics of a spasm-induced vessel site: minimal atherosclerosis and less calcification.…”

Section: Discussionsupporting

confidence: 61%

“…4,5) Previous intravascular ultrasound (IVUS) and optical coherence tomography (OCT) studies have reported the morphological features of vasospastic lesions. [6][7][8][9][10][11] However, most of the data were obtained in a spastic lesion that was artificially induced by the administration of a vasoconstrictor (acetylcholine or ergonivine). In the present report, we report IVUS images from a patient with ST elevation type acute myocardial infarction (STEMI) due to vasospasm.…”

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confidence: 99%

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A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

et al. 2013

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SummaryA 53-year-old male complaining of chest pain was admitted to our hospital with suspected acute myocardial infarction (AMI). Emergent coronary angiography (CAG) determined a totally occluded middle right coronary artery (RCA). Thrombus aspiration was conducted, followed by intravascular ultrasound (IVUS) imaging. Diffuse intima plus media thickness was identified at the obstruction site and a thrombus was observed proximally to the occlusion site on IVUS. Following isosorbide dinitrate (ISDN) administration, dilatation of the RCA was confirmed. IVUS study indicated the luminal dilatation was achieved by the release of the diffuse intima plus media thickening. Of note, plaque volume showed no significant difference after administration of ISDN at any vessel site. These results clearly show that luminal dilatation and vessel dilatation were achieved from the redistribution of plaque volume (intima plus media). A follow-up CAG showed no significant stenosis in the RCA. After a provocation test using methylergometrine maleate, the RCA was totally occluded at the very site of the initial event. The involvement of vasospasm as a cause of AMI in the present case was doubly confirmed with characteristic IVUS images of vasospasm in the acute phase and with a provocation test at follow-up. (Int Heart J 2013; 54: 237-239) Key words: Intravascular ultrasound, Intima and media thickening C oronary artery vasospasm has been shown to play an important role in the pathogenesis of ischemic heart disease, variant angina, myocardial infarction, and ventricular arrhythmia. [1][2][3] Previous studies have shown that the etiology of spasm is due to transient abnormal or hypersensitive response of vascular smooth muscle to various stimuli and that the atherosclerosis is invariably present at the site of focal vasospasm. 4,5) Previous intravascular ultrasound (IVUS) and optical coherence tomography (OCT) studies have reported the morphological features of vasospastic lesions. [6][7][8][9][10][11] However, most of the data were obtained in a spastic lesion that was artificially induced by the administration of a vasoconstrictor (acetylcholine or ergonivine). In the present report, we report IVUS images from a patient with ST elevation type acute myocardial infarction (STEMI) due to vasospasm. Case ReportA 53-year-old male complaining of chest pain at rest was admitted to our hospital.The patient had experienced 2-3 minutes of similar episodes once a month for 2 to 3 years. This time, his chest pain had lasted for more than 3 hours prior to the admission.Laboratory data showed a white blood cell count of 14460/mm 3 , creatine kinase (CK) of 3075 IU/L, CK-MB of 86.9 IU/L, and troponin-I of 16.2 ng/mL. An electrocardiogram (ECG) showed ST elevation in the II, III, and aV F leads and ST depression in the aV L lead. The data indicated an acute myocardial infarction. Emergent coronary catheterization was performed.Emergent coronary angiography showed a totally occluded RCA ( Figure 1A). Immediate percutaneous coronary intervention (P...

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Section: Discussionsupporting

confidence: 61%

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confidence: 99%

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

et al. 2013

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“…Nissen reported on intravascular US of the coronary arteries, which was found to be a promising technique without significant risk (15). In a study of angiographically normal sites in coronary artery disease patients, Yamagishi et al found that more than 75% had atherosclerotic abnormalities at US, emphasizing that coronary disease is often more diffuse than indicated by angiography (16). In a recent randomized trial comparing intensive and moderate lipid-lowering therapy on the progression of coronary atherosclerosis, IVUS successfully identified significant changes in the artery wall (17).…”

Section: Introductionmentioning

confidence: 99%

MRI of atherosclerosis in clinical trials

et al. 2006

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Magnetic resonance imaging (MRI) of the arterial wall has emerged as a viable technology for characterizing atherosclerotic lesions in vivo, especially within carotid arteries and other large vessels. This capability has facilitated the use of carotid MRI in clinical trials to evaluate therapeutic effects on atherosclerotic lesions themselves. MRI is specifically able to characterize three important aspects of the lesion: size, composition and biological activity. Lesion size, expressed as a total wall volume, may be more sensitive than maximal vessel narrowing (stenosis) as a measure of therapeutic effects, as it reflects changes along the entire length of the lesion and accounts for vessel remodeling. Lesion composition (e.g. lipid, fibrous and calcified content) may reflect therapeutic effects that do not alter lesion size or stenosis, but cause a transition from a vulnerable plaque composition to a more stable one. Biological activity, most notably inflammation, is an emerging target for imaging that is thought to destabilize plaque and which may be a systemic marker of vulnerability. The ability of MRI to characterize each of these features in carotid atherosclerotic lesions gives it the potential, under certain circumstances, to replace traditional trials involving large numbers of subjects and hard end-points -heart attacks and strokes -with smaller, shorter trials involving imaging end-points. In this review, the state of the art in MRI of atherosclerosis is presented in terms of hardware, image acquisition protocols and post-processing. Also, the results of validation studies for measuring lesion size, composition and inflammation will be summarized. Finally, the status of several clinical trials involving MRI of atherosclerosis will be reviewed.

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“…Spasm may also occur in proximity to atherosclerotic lesions including small lesions (2). Patients are often heavy cigarette smokers (3).…”

Section: Figure 1) a Electrocardiogram (Ecg) On Arrival (Precordial Lmentioning

confidence: 99%

Transient ST elevation due to coronary spasm in a young woman

Hovland

Bjørnstad

Mannsverk

2009

Canadian Journal of Cardiology

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A 43-year-old woman was admitted to the coronary care unit at Nordland Hospital (Bodø, Norway) because of a two-week history of transient chest pain. Her total cholesterol level was 8.0 mmol/L and she was a heavy cigarette smoker. On arrival, her vital signs were stable and she was pain-free. An electrocardiogram (ECG) showed inverted and biphasic T waves in the precordial leads ( Figure 1A), but after 30 min, she developed intense pressing chest pain and an ECG indicated severe anterior transmural ischemia ( Figure 1B). She was immediately transferred to the coronary care unit where the pain subsided in 5 min to 10 min. Echocardiography showed normal contractility in all coronary territories. A control ECG showed regression of the ST elevation ( Figure 1C

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Intravascular ultrasound detection of atherosclerosis at the site of focal vasospasm in angiographically normal or minimally narrowed coronary segments

Cited by 209 publications

References 19 publications

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

MRI of atherosclerosis in clinical trials

Transient ST elevation due to coronary spasm in a young woman

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