Clinical Outcome of Coronary Stenting in Patients with Variant Angina Refractory to Medical Treatment: A Consecutive Single-Center Analysis

Abstract

Objective: To investigate the efficacy of coronary stenting in patients with variant angina refractory to medical treatment. Subjects and Methods: Variant angina was diagnosed in 81 patients admitted to the Department of Cardiology between January 2003 and June 2011. However, coronary stenting was performed in 21 patients refractory to medical treatment, but coronary angiography and intravascular ultrasound were performed in all patients, and acetylcholine provocative test was performed in 11 of the 21 patients refractory to medical treatment. Coronary angiography was repeated after 9-12 months in the 21 patients with coronary stents. Clinical follow-up time was 2.5 ± 3.1 years (range 1-8). Results: Of the 81 patients, coronary angiography and intravascular ultrasound did not reveal significant stenosis in 13 (16.0%), but revealed 20-75% fixed stenosis in the remaining 68 (84.0%) patients. The acetylcholine provocative test was positive in the 11 patients. Of the 21 patients with coronary stents, the spasm site was located in the right coronary artery in 16 (76.2%) and in the left anterior descending artery in the remaining 5 (23.8%) patients. During the 1- to 8-year follow-up period, 1 of the 21 patients with stents developed recurrent episodes of variant angina, 5 patients had occasional chest pain, and the other 15 were asymptomatic. Coronary angiography at 9-12 months after initial evaluation demonstrated no stenosis in 3 patients, 20-40% in-stent mild intimal hyperplasia in 15 patients, and 50-80% in-stent restenosis in 3 patients. Coronary stenting was performed again in 2 patients. Conclusions: The present study showed that coronary stenting for severe refractory coronary vasospasm was effective and without serious complications. It can be an alternative and viable option for some patients who are refractory to medical therapy and at a high risk of acute coronary syndrome recurrence.

Intravascular ultrasound findings and stent implantation for a patient with coronary spastic angina at site of progressive atherosclerotic plaque and responded poorly to medical treatment: a case report

“…In accordance with the current case, other studies also reported plaque erosion at the site of coronary spasm, which indicates that intracoronary imaging can help to diagnose more complex cases at which standard coronary angiogram does not identify the possible problem or culprit [9–11]. And stent placement under the guidance of intracoronary imaging represents an attractive therapeutic option in patients with vasospastic angina refractory to aggressive medical therapy [12, 13].…”

Fatal Multi-Vessel Coronary Vasospasm: A Case Report

“…This was impossible for our patient case, who had multi-vessel vasospasms. Patients that are refractory to pharmacologic and percutaneous invasive therapy present most likely a severe vasomotor disorder and need more intensive long medical treatments and continued surveillance [10][11][12]. In some cases, despite good outcomes under medical treatment, 6.1% of patients suffer from ventricular arrhythmia events in the long outcome which requires implantable cardioverter-defibrillator (ICD) use as a considerable tool to improve the long-term prognosis [13].…”

Aborted Sudden Cardiac Death from Vasospastic-Induced Ventricular Fibrillation with Normal Coronary Angiography: A Case Report and Review of the Literature

“…While this is not standard treatment at the moment, it is a known option with some promising evidence already available. In a single-center analysis in China including 21 patients who underwent coronary stenting in the setting of refractory variant angina, only 1 patient continued to have recurrent episodes of variant angina with 5 patients experiencing occasional chest pain and the remaining 15 patients being asymptomatic [ 21 ]. The authors concluded that with additional supporting evidence, this could become a viable option for this cohort of patients.…”