Angiology: Open Access
Open Access

Abstract

A Case of Vasospastic Angina Involving Erosion and Thrombus within the Spastic Segment Detected by Coronary Angioscopy

Kido A, Fujii U, Oshita C, Ueda T and Teragawa H

A-58-year-old female who had been treated for vasospastic angina had difficulty in breathing and palpitations during rest at night. She was admitted to our institution for a detailed examination of her symptoms. Coronary angiography showed no obvious coronary stenosis. Thereafter, we performed the spasm provocation test (SPT), firstly in the right coronary artery (RCA) and then in the left coronary artery (LCA), using intracoronary infusions of acetylcholine. SPT revealed a focal spasm at the distal segment of RCA and diffuse spasms at the left anterior descending coronary artery (LAD) and left circumflex artery. An intracoronary infusion of nitroglycerin relieved coronary spasms. Coronary angioscopy revealed erosions and white thrombus at the spastic segment of the proximal segment of LAD. Administration of two types of coronary vasodilators improved chest symptoms. Recent studies have focused on acute coronary syndrome without plaque rupture, and coronary spasm has been proposed as one of the underlying mechanisms responsible. The findings of the present case may support a relationship between coronary spasm and coronary erosion with thrombus formation.