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.