Coronary arterial spasm detected by coronary computed tomography angiography and confirmed by intravascular ultrasound

Abstract

A 40-year-old man was admitted to our hospital for chest pain after smoking. Coronary computed tomography angiography showed severe stenosis in the left anterior descending artery. The stenosis site had no plaque on stretched curved multiplanar reconstruction and short-axis images. Coronary angiography revealed improvement of the severe stenosis after the intracoronary administration of isosorbide dinitrate in the left anterior descending artery. Intravascular ultrasound demonstrated negative remodeling without a plaque and diffuse intima with media thickening at the stenosis site. The chest pain was likely caused by coronary spastic angina, which was treated with diltiazem hydrochloride.

Left main coronary artery vasospasm: A case report of misdiagnosed severe coronary artery disease

“…Despite this, some patients with coronary spasm who are misdiagnosed with CAD during initial coronary angiography are at risk of undergoing unnecessary CABG surgery. To prevent unnecessary CABG surgery, repeat cardiac catheterization preferably with IVUS is a safe option that helps reevaluate and potentially recognize patients with coronary spasm [ 10 ]. However, this approach is invasive and puts the patient at risks related to the procedure.…”