Background: Vasospastic angina is a condition determined by epicardial coronary artery spasm, which is usually diagnosed from resting angina. Case Summary: A 62-year-old man was admitted for recurrent rest angina despite previous coronary artery bypass grafting and plain-old balloon angioplasty for multivessel disease. Coronary computed tomography angiography revealed occluded bypass grafts but nonsignificant coronary atherosclerosis, along with diffuse coronary ectasia and myocardial bridging. During invasive re-evaluation, intravascular ultrasound confirmed positive remodeling and intimal thickening, suggestive of vasospastic pathology. Critical, focal epicardial vasospasm during angiography triggered ventricular fibrillation, reversed by defibrillation. A transient right coronary artery occlusion with ST-elevation resolved with nitrates, highlighting the dynamic nature of the vasospasm. Discussion: The case emphasizes the importance of considering coronary vasospasm in patients with ambiguous angiographic findings, the diagnostic and therapeutic role of intracoronary nitroglycerin, and the value of imaging in avoiding unnecessary revascularization. Careful pharmacologic testing and physiologic assessment are essential to distinguish functional vasospasm from fixed coronary disease, especially in left main involvement.
Left Main Vasospasm Masquerading as Critical Stenosis Leading to Unnecessary Surgery / Di Lenarda, Francesca; Terzi, Riccardo; Gallazzi, Michele; Monizzi, Giovanni; Gallinoro, Emanuele; Paolisso, Pasquale; Marchetti, Davide; Conte, Edoardo; Bartorelli, Antonio L; Andreini, Daniele. - In: JACC. CASE REPORTS. - ISSN 2666-0849. - 30:29(2025). [10.1016/j.jaccas.2025.105231]
Left Main Vasospasm Masquerading as Critical Stenosis Leading to Unnecessary Surgery
Di Lenarda, Francesca;Paolisso, Pasquale;Marchetti, Davide;Conte, Edoardo;
2025
Abstract
Background: Vasospastic angina is a condition determined by epicardial coronary artery spasm, which is usually diagnosed from resting angina. Case Summary: A 62-year-old man was admitted for recurrent rest angina despite previous coronary artery bypass grafting and plain-old balloon angioplasty for multivessel disease. Coronary computed tomography angiography revealed occluded bypass grafts but nonsignificant coronary atherosclerosis, along with diffuse coronary ectasia and myocardial bridging. During invasive re-evaluation, intravascular ultrasound confirmed positive remodeling and intimal thickening, suggestive of vasospastic pathology. Critical, focal epicardial vasospasm during angiography triggered ventricular fibrillation, reversed by defibrillation. A transient right coronary artery occlusion with ST-elevation resolved with nitrates, highlighting the dynamic nature of the vasospasm. Discussion: The case emphasizes the importance of considering coronary vasospasm in patients with ambiguous angiographic findings, the diagnostic and therapeutic role of intracoronary nitroglycerin, and the value of imaging in avoiding unnecessary revascularization. Careful pharmacologic testing and physiologic assessment are essential to distinguish functional vasospasm from fixed coronary disease, especially in left main involvement.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
