Histological evaluation of coronary plaque in patients with variant angina: relationship between vasospasm and neointimal hyperplasia in primary coronary lesions

Suzuki, Hiromasa; Kawai, Sachio; Aizawa, Tadanori; Kato, Kazuzo; Sunayama, Satoshi; Okada, Ryozo; Yamaguchi, Hiroshi

doi:10.1016/s0735-1097(98)00520-8

Cited by 80 publications

(64 citation statements)

References 36 publications

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“…5 Reduction of blood flow due to coronary spasm activates platelets and the coagulation system, 6 causing vascular smooth muscle cell proliferation. 7 It has in fact been revealed by evaluation using quantitative coronary angiography that the locations of coronary spasm induced in provocation tests were particularly susceptible to progression of arteriosclerosis. 8,9 (…”

Section: Characterization Of Coronary Spasm In Ischemic Heart Diseasementioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2008) - Digest Version -

Group¹

2010

Circ J

231

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Coronary spasm is defined as a condition in which a relatively large coronary artery running on the surface of the heart transiently exhibits abnormal contraction. If a coronary artery is completely or nearly completely occluded by spasm, transmural ischemia occurs in the region perfused by the artery, which in turn causes anginal attacks with ST elevation on the ECG. If a coronary artery is partially occluded or diffusely narrowed by spasm, or if it is completely occluded by spasm but sufficient collateral flow has developed distally, nontransmural ischemia occurs, causing anginal attacks with ST depression on the ECG. These pathological conditions are collectively termed vasospastic angina (also termed coronary spastic angina), as a type of angina caused by coronary spasm. Variant angina, characterized by ST elevation during anginal attacks, is another type of vasospastic angina. Coronary spasm has been shown to play key roles in the onset of not only variant angina but also rest angina, effort angina, acute myocardial infarction, and other related conditions. 1 The mechanism of involvement of coronary spasm in the onset of acute coronary syndrome is now being elucidated. 2-4In drawing up the present guidelines, cases of vasospastic angina were categorized into three classes as described below. Please note that no evidence levels are established for the guidelines, since no large-scale clinical studies of this condition have been performed. Classification of Recommendations

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Section: Characterization Of Coronary Spasm In Ischemic Heart Diseasementioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2008) - Digest Version -

Group¹

2010

Circ J

231

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“…Intimal hemorrhage was observed at the spasm-induced site. 6) A case of coronary artery disruption due to coronary spasm and intramural hemorrhage has not been previously reported.…”

Section: Discussionmentioning

confidence: 98%

Coronary Arterial Wall Disruption and Intramural Hematoma in a Patient With Coronary Spastic Angina

et al. 2012

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SummaryAcute myocardial infarction is sometimes complicated in patients with coronary spastic angina. The mechanisms are known to be plaque rupture and thrombosis induced by spasm, and reduced coronary flow due to prolonged spasm. We describe the case of a 45-year-old woman with coronary spastic angina who had a complication of an acute myocardial infarction. A specimen obtained with thrombectomy was the disrupted coronary artery wall accompanied by massive intramural hemorrhage. The cause of the acute myocardial infarction was thought to be an embolism of the coronary arterial wall that was disrupted by spasm and intramural hemorrhage. (Int Heart J 2012; 53: 68-71) Key words: Coronary spastic angina, Intramural hemorrhage, Acute myocardial infarction A cute myocardial infarction is sometimes complicated in patients with coronary spastic angina. The causes are known to be plaque rupture and thrombosis induced by spasm, and reduced coronary flow due to prolonged spasm.Coronary spastic angina is also implicated in the progression of coronary atherosclerosis. The mechanisms of the progression are intimal hyperplasia due to intimal injury and intramural hemorrhage. [1][2][3] Experimental studies have shown that intramural hemorrhages are induced at spastic sites by repetitive coronary spasms.2,3) However, it is difficult to show intramural hemorrhages in clinical settings. We describe here a patient with coronary spastic angina whose severe spasm led to intramural hemorrhage and coronary arterial wall disruption. Case ReportA 45-year-old woman was admitted to our hospital because of a chest pain attack. She had no previous medical history. Five months before admission, she had experienced a chest pain attack at rest. An electrocardiogram (ECG) conductFrom the

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“…The most common histological appearance of patients with variant angina is neointimal hyperplasia [1]. In the first case, p-RCA of non-culprit lesion had a plaque type of fibroatheroma with VH-IVUS that had relatively small amount of necrotic core.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that acute myocardial infarction or sudden death may occur in patients with variant angina, even with no or insignificant organic coronary stenosis [1]. Moreover, most of variant angina has lots of plaque, though it has insignificant stenosis on angiogram.…”

Section: Introductionmentioning

confidence: 99%

Rapid decrease of necrotic core after acute myocardial infarction

Lee¹,

Shin²,

Kim³

et al. 2012

WJCD

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It is well known that the increase of necrotic core in previous atherosclerotic coronary artery disease is one of the conditions of vulnerable plaque. However, it is not known how fast necrotic core could decrease in a vulnerable plaque. We had 2 patients who had suffered from acute myocardial infarction and had large amount of necrotic core in their culprit lesions at baseline, which decreased markedly within 7 days. Also, they were clinically stable and asymptomatic over 1 year follow-up. It is first report to show markedly decrease of necrotic core amount within only 7 days in culprit lesions of 2 cases of acute myocardial infarction with angiographically minimal lesions.

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Histological evaluation of coronary plaque in patients with variant angina: relationship between vasospasm and neointimal hyperplasia in primary coronary lesions

Abstract: Coronary vasospasm may provoke vascular injury that leads to the formation of neointima in VAP patients similar to that seen with restenosis. Coronary spasm may thus play a key role in the rapid coronary stenosis progression in certain patients with VAP.

Cited by 80 publications

References 36 publications

Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2008) - Digest Version -

Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2008) - Digest Version -

Coronary Arterial Wall Disruption and Intramural Hematoma in a Patient With Coronary Spastic Angina

Rapid decrease of necrotic core after acute myocardial infarction

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