Spontaneous resolution of mid-segment coronary vasospasm previously unresponsive to intracoronary nitroglycerin

Excerpt

We present an image of a 51-year-old female smoker who was admitted with angina. There was no history of cocaine or any other drug use. The coronary angiography showed a significant focal narrowing involving the mid-segment of the left anterior descending coronary artery (LAD), which persisted despite routine intracoronary injection of 200 μg nitroglycerin (Fig. 1a). The abnormal finding in Fig. 1a was considered to be a significant atherosclerotic stenosis. Therefore, the lesion was not further evaluated by giving other vasodilators such as adenosine. The left main, left circumflex and right coronary arteries were normal. She remained asymptomatic throughout the angiography and was scheduled for drug-eluting stent implantation to be performed on the next day. At the second catheterisation, we observed that the significant narrowing in the mid-segment of the LAD had disappeared completely (Fig. 1b). The procedure was discontinued without stenting and the patient was successfully treated with a calcium-channel blocker.

…