Limited role of coronary angioplasty and stentingin coronary spastic angina with organic stenosis
Yasuhiko Tanabe, MD*,*,
Eiichi Itoh, MD*,
Kaoru Suzuki, MD*,
Masahiro Ito, MD*,
Yukio Hosaka, MD*,
Iwao Nakagawa, MD* and
Makoto Kumakura, MD*
* Department of Cardiology, Niigata Prefectural Shibata Hospital, Shibata, Japan
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Figure 1 Flow chart of spasm provocative testing before percutaneous coronary intervention (PCI) and at follow-up in a group of 30 patients with spasm superimposed on the severe organic stenosis before PCI (A) and in group of 15 patients without spasm superimposed on the severe organic stenosis before PCI (B).
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Figure 2 Flow chart of spasm provocative testing before percutaneous coronary intervention and at follow-up in a group of 20 patients treated with balloon angioplasty alone (A) and in a group of 25 patients treated with intracoronary stenting (B). *Twenty patients with spasm induced at a site different from the initial stenosis in the dilated vessel on follow-up provocation, including seven patients with spasm induced at the edge of the implanted stent.
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Figure 3 Initial (A, B) and follow-up (C, D) angiograms of the left coronary artery obtained in the right anterior oblique projection. (A) Intracoronary injection of 50 µg acetylcholine (ACh) induced occlusive spasm at the site of severe stenosis (arrow). (B) After intracoronary injection of isosorbide dinitrate (ISDN), severe organic stenosis was present at the proximal left anterior descending coronary artery (arrow). (C) Intracoronary injection of 50 µg ACh induced subocclusive spasm at the edge of the stent (arrowhead) in the left anterior descending coronary artery, as well as occlusive spasm in the proximal left circumflex coronary artery; the stented portion at the site of the initial stenosis (arrow) was free of vasoconstriction. (D) After intracoronary injection of ISDN, there was no restenosis at the initial stenosis (arrow) that had been dilated by intracoronary stenting.
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