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A 56 year old man was hospitalised for unstable angina. Coronary angiogram revealed a tight and isolated stenosis of the mid right coronary artery (top).
Coronary angioplasty was undertaken following the usual procedure (middle), during which multiple spasms were observed in the proximal and mid segments of the right coronary artery. The patient only felt moderate chest pain, and a modest ST segment elevation in the inferior leads was observed. Fortunately the spasm was successfully treated by intracoronary vasodilators (nitrates and verapamil).
The procedure was completed with two new inflations with a stent-like result (bottom); no immediate complications or long term restenosis occurred.
Though coronary artery spasm has been reported in 1–5% of balloon angioplasty procedures, it usually occurs at the site of the treated lesions or in the distal vessel. The multiple spasms in the proximal and mid epicardial artery observed in our patient are unusual, and probably resulted from irritation of the artery by the angioplasty equipment.