Successful management of intractable coronary spasm with a coronary stent

Although the long-term survival of patients suffering from coronary spasm i s usually excellent, serious complications can develop, such as disabling p ain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an a cute anterior myocardial infarction upon first admission. The patient under went a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was heated by t he combination of nitrate and calcium channel blocker, but continued to com plain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period . An ergonovine coronary angiogram was performed and an intracoronary ultra sound examination, which revealed a focal spasm at the same site of the pro ximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms reso lved. A follow-up coronary angiogram was performed 3 years after stenting a nd the stent remained patent without any in-stent restenosis or spasm.