Li Yuxin, Honye Junko, Takayama Tadateru, Saito Satoshi
Int J Cardiol. 2007 Jul 10;119(2):251-4. doi: 10.1016/j.ijcard.2006.07.137. Epub 2006 Oct 24.
Coronary spasm may be one of the reasons for the appearance of chest pain after successful percutaneous coronary interventions, and is potentially hazardous when myocardial ischemia occurs. Coronary spasm can be diagnosed by intracoronary administration of ergonovine as a selective spasm provocative test. We report here the case of a patient who had chest pain and ST segment elevation 10 days after successful right coronary artery stent implantation. Repeat angiography was performed, with results of no in-stent stenosis and no stenosis in other segments. Since coronary artery spasm was considered as a possible reason, a spasm provocative test was attempted. Following ergonovine administration (total dose, 50 mug) into the right coronary artery, severe spasm with 99% stenosis developed over the whole artery except the stented segment. Isosorbide dinitrate was injected immediately, and the provoked spasm was soon relieved. Intravascular ultrasound revealed no neointima at the stented segment and diffuse and mild low-echogenic concentric plaque at the distal as well as proximal segment of the stent. Most reports regarding coronary artery spasm provocative tests have focused on focal lesions before interventional therapy, or during interventional procedures. Although it is quite rare, potential coronary spasm should be considered when chest symptoms recur after percutaneous coronary interventions without angiographic representation.
冠状动脉痉挛可能是经皮冠状动脉介入治疗成功后出现胸痛的原因之一，当发生心肌缺血时具有潜在危险性。冠状动脉痉挛可通过冠状动脉内注射麦角新碱作为选择性痉挛激发试验来诊断。我们在此报告一例患者，其在右冠状动脉支架植入成功后10天出现胸痛和ST段抬高。进行了重复血管造影，结果显示支架内无狭窄且其他节段无狭窄。由于考虑冠状动脉痉挛可能是原因，尝试进行了痉挛激发试验。向右冠状动脉内注射麦角新碱（总剂量50μg）后，除支架段外，整个动脉出现严重痉挛，狭窄达99%。立即注射硝酸异山梨酯，激发的痉挛很快缓解。血管内超声显示支架段无新生内膜，支架远端及近端节段有弥漫性轻度低回声同心斑块。大多数关于冠状动脉痉挛激发试验的报告都集中在介入治疗前或介入过程中的局灶性病变。虽然相当罕见，但在经皮冠状动脉介入治疗后无血管造影表现而胸痛症状复发时，应考虑潜在的冠状动脉痉挛。
