[Histological evidence of prolonged coronary artery spasm in a necropsy case of recurrent myocardial infarction].

A 69-year-old male had acute inferior infarction during an operation of an aneurysm of the abdominal aorta and died from multiple organ failure 3 weeks after the operation. His initial coronary angiogram (CAG) showed no significant stenosis, but repeated CAG showed that the patients had developed a prolonged spasm in the mid-portion of the right coronary artery. Histologically, we observed eccentric luminal narrowing with atheromatous plaque where the spasms had been demonstrated, and a "waving form" of elastic fibers accompanied by intimal thickening in the opposite site of the atheromatous plaque. These findings suggest that organic stenosis may be underestimated angiographically because of compensatory enlargement of the non-atheromatous site in some patients with coronary artery spasm, and prolonged spasms may augment organic stenosis by following intimal thickening.