A change in the pattern of vasospasm after stenting in a patient with vasospastic angina

Wada, Masamichi; Hara, Hisao; Nakamura, Masato

doi:10.1007/s00380-006-0920-6

Cited by 5 publications

(7 citation statements)

References 12 publications

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“…This finding emphasizes that NO-mediated response is well maintained even in the diseased coronary artery if the endothelium functions normally. On the other hand, human coronary arteries with endothelial dysfunction are sometimes poor response to organic nitrates during an ischemic attack [3]. As also suggested from the current study, whether NO-donating drugs can exert enough coronary dilating effects in ischemic heart diseases is likely to depend on the condition of the endothelium.…”

Section: Discussionmentioning

confidence: 59%

“…This dilation is mediated through the conversion of nitrate to nitric oxide (NO) in the body, activation of soluble guanylate cyclase (sGC), and subsequent increase in cGMP [2]. In the clinical setting, however, there are cases where a patient is refractory to treatment with organic nitrates [3,4,5]. This phenomenon cannot be explained just by the phenomenon of nitrate tolerance [6].…”

Section: Introductionmentioning

confidence: 99%

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Responsiveness of Coronary Arteries to Nitroglycerin under Hypoxia: The Importance of the Endothelium

Tawa

Shimosato²,

Saito³

et al. 2017

Pharmacology

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Background/Aims: Nitroglycerin is widely used as a coronary vasodilator in the treatment of ischemic heart diseases. This study investigated the influence of hypoxia on nitroglycerin-induced relaxation in endothelium-intact and -denuded rabbit, monkey, and porcine coronary arteries. Methods: Helically cut strips of coronary arteries were suspended in organ chambers, and isometric tension was recorded. Results: Nitroglycerin concentration dependently relaxed endothelium-intact rabbit coronary arteries, which were not different under normoxic and hypoxic conditions. On the other hand, nitroglycerin-induced relaxation of endothelium-denuded arteries was significantly attenuated by hypoxia. Similarly, the relaxant response of endothelium-intact monkey coronary arteries to nitroglycerin was not affected by hypoxia, whereas that of endothelium-denuded arteries was impaired. As is the case with rabbit and monkey coronary arteries, exposure to hypoxia resulted in impaired relaxation by nitroglycerin in endothelium-denuded but not endothelium-intact porcine coronary arteries. Conclusion: These findings suggest that coronary endothelium plays a pivotal role in preventing the hypoxia-induced impairment of nitroglycerin responsiveness, regardless of the animal species.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Responsiveness of Coronary Arteries to Nitroglycerin under Hypoxia: The Importance of the Endothelium

Tawa

Shimosato²,

Saito³

et al. 2017

Pharmacology

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“…provocative tests may be helpful in posing the diagnosis. [21][22][23][24] To further evaluate the clinical relevance of a moderate MB observed during coronary angiography the FFR measurement in this specifi c region may also be of great interest in the decision making of when and how to treat this coronary milking phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Coronary myocardial bridge: an innocent bystander?

et al. 2008

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Myocardial bridge (MB) or tunneled coronary artery is an inborn abnormality, which implicates a systolic vessel compression with a persistent mid-late diastolic diameter reduction. Myocardial bridges are often observed during coronary angiography with an incidence of 0.5%-5.5%. The most involved coronary artery is the left anterior descending artery followed by the diagonal branches, the right coronary artery, and the left circumflex. The overall long-term prognosis is generally benign. However, several risk or precipitating factors (e.g., high heart rate, left ventricular hypertrophy, decreased peripheral vascular resistance) may trigger symptoms (most frequently angina). Herein, we describe two cases of symptomatic myocardial bridge, where medical treatment (i.e., inotropic negative drug) and coronary stenting were successfully utilized to treat this pathology. We also focus on the clinical presentation, and the diagnostic and therapeutic modalities to correctly manage this frequently observed congenital coronary abnormality, underlining the fact that in cases of typical angina symptoms without any significant coronary artery disease, MB should be considered as a possible differential diagnosis.

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“…Non-pharmacological therapies for medically refractory CSA have been documented (60)(61)(62)(63)(64)(65)(66)(67)(68). Percutaneous coronary stenting has been shown to be effective in such cases without organic coronary stenosis (60,61,63) and in patients with organic coronary stenosis (62,64).…”

Section: Non-pharmacological Treatment For Medically Refractory Coronmentioning

confidence: 99%

“…Most of the studied patients had organic coronary stenosis, and the restenosis rate remains unclear in patients with CSA without organic coronary stenosis. Furthermore, in several studies coronary spasm continued to occur in the stented vessel or in other vessels after stenting, but did not occur at the stented lesion (65,67,68). Pharmacological therapy with vasodilators such as long-acting CCBs is essential in patients with medically refractory CSA, even though symptoms improve after coronary stenting.…”

Section: Non-pharmacological Treatment For Medically Refractory Coronmentioning

confidence: 99%

Treatment of Coronary Spastic Angina, Particularly Medically Refractory Coronary Spasm

Teragawa

Nishioka

Higashi

et al. 2008

Clinical medicine. Cardiology

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Abstract:Coronary spasm plays an important role in the pathogenesis of variant angina as well as ischaemic heart diseases. Treatment with vasodilators such as long-acting calcium channel blockers and long-acting nitrates is generally effective in preventing coronary spasm; however, in some patients coronary spasm is refractory to standard therapy. Because of endothelial dysfunction, hyper-reactivity of coronary smooth muscle cells and other triggering factors involved in the pathogenesis of coronary spasm, drugs capable of improving these conditions may be effective in preventing medically refractory coronary spasm. In addition, a spasm provocation test is frequently performed when diagnosing coronary spasms. Although intracoronary administration of nitroglycerin generally relieves the coronary spasm that results from this test, we have encountered patients who suffered haemodynamic instability during the test. Drugs that stabilize haemodynamics and dilate the coronary artery are effective in such situations. We review treatment options for coronary spasm that are refractory to the standard oral medications and to intracoronary infusion of nitroglycerin during the spasm provocation test.

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A change in the pattern of vasospasm after stenting in a patient with vasospastic angina

Cited by 5 publications

References 12 publications

Responsiveness of Coronary Arteries to Nitroglycerin under Hypoxia: The Importance of the Endothelium

Responsiveness of Coronary Arteries to Nitroglycerin under Hypoxia: The Importance of the Endothelium

Coronary myocardial bridge: an innocent bystander?

Treatment of Coronary Spastic Angina, Particularly Medically Refractory Coronary Spasm

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