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A 47 year old woman with variant angina and recurrent ischaemic episodes, despite aggressive medical treatment, was referred to our attention. Coronary angiography showed a normal left coronary artery and significant obstruction of the middle portion of the right coronary artery (upper panel, centre), that was successfully treated with stent implantation (lower panel, centre). At the end of the procedure, the patient complained of chest pain associated with ST segment elevation in the anterior precordial leads. Repeated angiography showed absence of residual stenosis with normal run-off of the right coronary artery, but a localised spasm in the middle portion of both circumflex and left anterior descending coronary arteries (upper panel, right). Spasms were promptly relieved by intracoronary glyceryl trinitrate (lower panel, right).
The possibility that coronary stretching, caused by stent deployment, could trigger coronary spasm in remote coronary arteries has to be taken into account during coronary interventions in the presence of acute postprocedural ischaemia.