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Case Reports
. 2017 Dec 7:2017:bcr2017222607.
doi: 10.1136/bcr-2017-222607.

Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance

Masaki Kodaira  1 , Ryota Tabei  1 , Toshiki Kuno  1 , Yohei Numasawa  1
Affiliations
Case Reports

Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance

Masaki Kodaira et al. BMJ Case Rep. .

Abstract

A 46-year-old man underwent coronary angiography for stable angina. He developed inferior ST-segment myocardial infarction during the angiography. Intravascular ultrasound (IVUS) findings suggested coronary vasospasm. Intracoronary administration of isosorbide dinitrate restored the coronary flow. This case illustrates the essential role IVUS imaging played in establishing the diagnosis of catheter-induced coronary vasospasm.

Keywords: clinical diagnostic tests; ischaemic heart disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Initial angiography of the right coronary artery.
Figure 2
Figure 2
ECG and coronary angiography after development of chest pain. ECG recorded after the patient experienced chest pain (A). ST-segment elevation was noted in leads II, III, arteriovenous fistula (aVF) (yellow arrows). Repeated angiography of the right coronary (white arrow) artery after appearance of symptoms and haemodynamic collapse (B).
Figure 3
Figure 3
Images after development of chest pain. Intravascular ultrasound imaging of the occluded right coronary artery at the vasospastic lesion (A) and the distal lesion showing positive remodelling (B). Yellow arrows point to the medial thickening.
Figure 4
Figure 4
Results after restoration of the coronary flow. Angiography of the right coronary artery just after administration of isosorbide dinitrate (A). Intravascular ultrasound imaging of the right coronary artery after restoring flow showing the vasospastic lesion being dilated (B), and the distal lesion showing more remarkable signs of positive remodelling (C).
See this image and copyright information in PMC

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