Lack of compensatory enlargement at sites of coronary vasospasm: Identification by ultrasound and successful treatment with stenting

The case of a young man with spontaneous vasospasm at two sites in his left anterior descending coronary artery is described. Intravascular ultrasound demonstrated mild eccentric atherosclerosis with smaller total artery cros s-sectional area (defined as the external elastic membrane) compared with r eference segments. Impaired compensatory enlargement (remodeling) in respon se to mild atherosclerosis may derive from one or more biologic mechanisms that are also responsible for vasospasm. This characteristic is easily iden tified by intravascular ultrasound. In this case, coronary stenting of the vasospastic sites led to excellent long-term control of symptoms more than 1 year after intervention.