Acute coronary occlusion likely due to thrombus occurring during coronary angiography

✍ Scribed by Dalby, Miles

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 9 KB
• Volume: 44
• Category: Article
• ISSN: 0098-6569
• DOI: 10.1002/(sici)1097-0304(199808)44:4<459::aid-ccd28>3.0.co;2-c

✦ Synopsis

We thank Drs. Goel and Kapoor for their comments concerning our article, ''Stent Placement for Recurrent Vasospastic Angina Resistant to Medical Treatment'' [1]. It is very difficult to predict the other coronary spastic site, especially when the segment is angiographically normal, because angiography can image only the silhouette of the vessel lumen and may miss intramural disease. Recently, intravascular ultrasound (IVUS) images have enabled visualization of the intraluminal and intramural morphology of the coronary arteries. IVUS images disclosed the morphological characteristics such as thickening of the intimal leading edge and increased sonolucent zone in focal coronary vasospasm even in the absence of significant angiographic abnormalities [2]. The existence of atherosclerosis is thus related to the occurrence of focal vasospasm.

Although Goel et al. did not refer to the treatment in their case, medications such as calcium channel blockers and long-acting nitrates remain the first choice. Coronary stenting would be considered when the medical treatment is not successful or torelated [3] and stents should not be randomly placed. Unfortu-nately, IVUS study was not performed in our case; however, it can be an useful diagnostic tool to determine the location of stent placement and to exclude spasm at other sites in cases of vasospastic angina resistant to medical treatment.