Korean Circ J.  2011 Jan;41(1):43-45. 10.4070/kcj.2011.41.1.43.

Isolated Left Main Coronary Artery Spasm Detected by Multidetector Computed Tomography

• Kang MK
• Jeong YH
• Yoon SE
• Koh JS
• Jung KT
• Park Y
• Hwang SJ
• Kwak CH
• Jeon KN
• Hwang JY

• KMID: 2225154
• DOI: http://doi.org/10.4070/kcj.2011.41.1.43

Abstract

Although atherosclerotic obstruction is the main cause of left main coronary artery (LMCA) disease, it can also be associated with vasospasm. We report a case of a 61-year-old male who presented with ostial stenosis of the LMCA, detected by 64-slice multi-detector computed tomographic coronary angiography (MDCT-CA). Careful review of MDCT and intravascular ultrasound findings showed suspicion of an isolated spasm of the LMCA without a significant atherosclerotic lesion. The patient was successfully treated with nitrates and a calcium channel blocker.

Keyword

Coronary vessels; Coronary vasospasm; Computed tomography, spiral; Interventional ultrasonography

MeSH Terms

Calcium Channels
Constriction, Pathologic
Coronary Angiography
Coronary Vasospasm
Coronary Vessels
Humans
Male
Middle Aged
Multidetector Computed Tomography
Nitrates
Spasm
Tomography, Spiral Computed
Ultrasonography, Interventional
Calcium Channels
Nitrates

Figure

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  Fig. 1 MDCT showed >50% ostial stenosis of the LMCA (A and B). Coronary angiography demonstrated significant narrowing of the LMCA before infusion of nitroglycerine (C) and adequate dilation of the LMCA after infusion of nitroglycerine (D). MDCT: multi-detector computed tomography, LMCA: left main coronary artery.

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  Fig. 2 IVUS imaging after intracoronary administration of 200 µg nitroglycerine showed persistent negative remodeling of the LMCA without significant atherosclerotic change (A). After additional administration of 500 µg nitroglycerin, a dilated LMCA without evidence of negative remodeling was noted (B). IVUS: intravascular ultrasound, LMCA: left main coronary artery.

Reference

1. Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary arteryspasm: clinical features, diagnosis, pathogenesis, and treatment. J Cardiol. 2008. 51:2–17.

2. Chuang YT, Ueng KC. Spontaneous and simultaneous multivessel coronary spasm causing multisite myocardial infarction, cardiogenic shock, atrioventricular block, and ventricular fibrillation. Circ J. 2009. 73:1961–1964.

3. Parakh N, Singh S, Math RS, Sharma S, Bahl VK. Catheter-induced left main coronary artery spasm. J Cardiovasc Med (Hagerstown). 2009. 10:288–289.

4. Pflederer T, Marwan M, Ropers D, Daniel WG, Achenbach S. CT angiography unmasking catheter-induced spasm as a reason for left main coronary artery stenosis. J Cardiovasc Comput Tomogr. 2008. 2:406–407.

5. Park SJ, Kim YH, Park DW, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009. 2:167–177.

6. Yoo SY, Kim JY. Recent insights into the mechanisms of vasospastic angina. Korean Circ J. 2009. 39:505–511.

7. Lee KH, Lee H, Bae MH, et al. Gender differences among Korean patients with coronary spasm. Korean Circ J. 2009. 39:423–427.