Plaque Morphology at Coronary Sites With Focal Spasm in Variant Angina-Study Using Intravascular Ultrasound-

Saito, Satoshi; Yamagishi, Masakazu; Takayama, Tadateru; Chiku, Masaaki; Koyama, Jun; Ito, Kenichi; Higashikata, Takeo; Seguchi, Osamu; Honye, Junko; Kanmatsuse, Katsuo

doi:10.1253/circj.67.1041

Cited by 48 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: 84%

“…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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confidence: 84%

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confidence: 99%

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

et al. 2013

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“…Usually, medical treatment with nitrates or calcium antagonists is the treatment of choice in this condition and beta blocker therapy is discontinued. However, there are patients who are refractory to oral therapy similar to our case [1,2]. Although the FFR measurement demonstrated no ischaemia in the absence of spasm, additional IVUS demonstrated a large plaque burden.…”

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confidence: 64%

A cataclasm due to spasm

2012

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We describe a 59-year-old patient presenting with ST-elevation acute coronary syndrome. Coronary angiography with intravascular ultrasound (IVUS) showed an important nonsignificant atherosclerotic lesion in the proximal left anterior descending artery (LAD) and presence of bridging in the mid-LAD. Our hypothesis was that focal spasm at this site was the cause of transmural ischaemia; therefore, treatment was given by performing a percutaneous coronary intervention (PCI) of the lesion. The patient remained symptom-free which confirmed our conclusion. The myocardial bridging had no clinical implications at this moment.Keywords Coronary spasm . Myocardial bridging . Intravascular ultrasound A 59-year-old negroid male presented to the emergency department with chest pain. His previous medical history consisted of heterozygous alpha thalassaemia type 2, reflux disease and lumbar hernia. A coronary angiogram 6 years ago had shown only slight vessel wall abnormalities. Cardiac risk factors were hypertension, a positive family history for coronary artery disease and nicotine abuse in the past. There was no history of cocaine abuse. During the last 5 months he had been complaining of sudden chest pain occurring at rest, which radiated to the left arm and only lasted for roughly 10 min. He had never had any exerciseinduced symptoms. The pain also reacted swiftly to sublingual nitrate. An exercise test performed in the week before his admission showed no abnormalities. His current medication was acetylsalicylic acid, amlodipine, losartan, bisoprolol, proton pump inhibitor and ranitidine. Blood pressure was 129/79 mmHg with a pulse of 53 beats/min. Further physical examination revealed no abnormalities. The symptom-free electrocardiogram showed sinus rhythm and diffuse repolarisation abnormalities with T-wave inversion in leads II, III and V4 to V6. During chest discomfort, there was ST elevation in leads I, aVL, and V2 to V6 with reciprocal depression in leads III and aVF (Fig. 1). Laboratory tests showed no abnormalities and the cardiac enzymes remained normal. He was treated for an acute coronary syndrome with clopidogrel, fraxiparine and intravenous nitroglycerin. Coronary angiography showed 50 % stenosis of the proximal LAD (Fig. 2), myocardial bridging of the mid LAD, 90 % stenosis of the first and second diagonal branch and 70 % stenosis of margo obtuse and posterolateral branches. The culprit lesion appeared to be the proximal LAD as this could explain the electrographic changes. Due to the fact that this stenosis did not seem to be significant on visual assessment, an FFR measurement was performed. This showed a value of 0.96; therefore, the lesion was not considered to be haemodynamically important and PCI was not performed. Although the angiogram showed no evidence of coronary spasm the clinical evidence started to point in this direction. After discontinuing bisoprolol and under treatment with maximum doses of oral nitrate and calcium antagonist he had recurring short and sudden episodes of chest pain. ...

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“…6,7 Evaluation of intimal thickening of the coronary artery is thought to be important clinically and recent advancements in intravascular ultrasound (IVUS) have enabled pathological evaluation of the wall structure of the coronary artery. [8][9][10][11][12][13][14][15] However, intimal thickening is indirectly evaluated as the intima -media thickness (IMT) by IVUS because the boundary of the intima and media cannot be distinguished completely by this method. 16 Optical coherence tomography (OCT) is a new imaging method [17][18][19][20][21][22] with a resolution of approximately 10-20 m, which is approximately 10-fold greater than that of IVUS.…”

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Assessment of Coronary Intima - Media Thickness by Optical Coherence Tomography Comparison With Intravascular Ultrasound

Kume

Kawamoto

Watanabe

et al. 2005

Circ J

199

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ntimal thickening is considered to be an early phase of atherosclerosis; [1][2][3][4][5] in the coronary artery it is related to coronary spasm and is of prognostic importance in patients after cardiac transplantation. 6,7 Evaluation of intimal thickening of the coronary artery is thought to be important clinically and recent advancements in intravascular ultrasound (IVUS) have enabled pathological evaluation of the wall structure of the coronary artery. [8][9][10][11][12][13][14][15] However, intimal thickening is indirectly evaluated as the intima -media thickness (IMT) by IVUS because the boundary of the intima and media cannot be distinguished completely by this method. 16 Optical coherence tomography (OCT) is a new imaging method [17][18][19][20][21][22] with a resolution of approximately 10-20 m, which is approximately 10-fold greater than that of IVUS. 23 OCT can easily identify the internal elastic laminae, which cannot be identified by IVUS. 18,19 We thus hypothesized that OCT could enable more accurate measurement of the IMT and the intimal thickness than IVUS, so the aim of the present study was to test these hypotheses. MethodsWe examined 54 randomly selected segments from 54 coronary arteries from 18 consecutive cadavers (10 males, 8 females; mean age 72±6 years). The cause of death was leukemia (n=3), lung cancer (n=3), acute myocardial infarction (n=2), pulmonary embolism (n=2), intracranial hemorrhage (n=2), liver cirrhosis (n=2), pneumonia (n=2), Circulation Journal Vol.69, August 2005and trauma (n=2). The study protocol was approved by the ethics committee of Kawasaki Medical School, and written informed consent was obtained from each family. An approximate 5-cm length of the proximal site of the 3 major coronary arteries, the left anterior descending coronary artery, left circumflex artery, and right coronary artery, were obtained from cadavers at autopsy within 3 h of death. The surrounding soft tissue was dissected from each specimen. Small arterial perforators and the branches were tied off with sutures, and the distal end of the artery was occluded with a large cork. A 7F sheath was sewn into the proximal end of the artery to complete the closed system. Phosphate-buffered saline (154 mmol/L NaCl, 10 mmol/L NaH2PO4, pH 7.4), which was kept at 37°C, was infused through the side arm of the sheath. The pressure inside the coronary artery was maintained at a physiological level (60-80 mmHg) with a sphygmomanometer connected to the infusion. OCT and IVUS ImagesAn intravascular OCT catheter (ImageWire ® , LightLab Imaging, Westford, MA, USA) and IVUS catheter (Atlantis SR Pro ® 2.5F, 40-MHz, Boston Scientific, Natick, MA, USA) were inserted through the diaphragm of the sheath. Serial OCT and IVUS images were obtained using an automatic pullback device at a rate of 0.5 mm/s. The OCT images were processed and analyzed using proprietary software from LightLab Imaging, Inc and the IVUS images were exported to commercially available image processing software (Netra 3D IVUS system, ScImage) for off-lin...

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Plaque Morphology at Coronary Sites With Focal Spasm in Variant Angina-Study Using Intravascular Ultrasound-

Cited by 48 publications

References 33 publications

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

A cataclasm due to spasm

Assessment of Coronary Intima - Media Thickness by Optical Coherence Tomography Comparison With Intravascular Ultrasound

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