Catheter-Induced Coronary Spasm: Serious But Preventable

J INVASIVE CARDIOL 2017;29(12):E202.

Key words: catheter-induced spasm, complications, cardiac imaging

A 44-year-old man presented with typical angina. He previously received a subcutaneous implantable cardioverter defibrillator after a cardiac arrest episode several years ago in another facility. Nuclear myocardial perfusion stress test demonstrated reversible anterolateral ischemia. Upon engagement of the left main (LM) coronary artery with a JL4 catheter, the patient developed chest pain with ST elevations and severe LM stenosis was observed (Figure 1; Video 1). A total of 400 µg intracoronary nitroglycerin were administered. The patient’s chest pain and ST elevations resolved. Repeat angiography demonstrated almost complete resolution of LM spasm (Figure 2; Video 2).​ No other significant coronary artery disease was found. 

Catheter-induced spasm can mostly be prevented by avoiding deep cannulation of the coronary arteries and the use of less aggressive catheters. While catheter-induced spasm is considered to be rare, it needs to be ruled out (especially in cases of LM stenosis) to avoid unnecessary revascularization.^1,2 In this patient, however, the underlying tendency for coronary spasm was so high, it is conceivable that the severe coronary spasm was the underlying cause of his prior cardiac arrest episode.

View accompanying videos here.

References

1.    Ali F, Faraz HA, Siddiqui MU. Left main coronary artery spasm — a rare entity as a cause of myocardial infarction in a patient. J Invasive Cardiol. 2013;25:E36-E38.

2.    Ilia R, Shimony A, Cafri C, Weinstein JM. Angiographic characteristics of catheter-induced spasm of the left main coronary artery. Am J Cardiol. 2016;117:571-573. 

From ¹Case Western Reserve University, School of Medicine, Cleveland, Ohio; and ²Middle Georgia Heart and Vascular Center, Macon, Georgia.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted May 19, 2017.

Address for correspondence: Farshad Forouzandeh, MD, PhD, FACC, Assistant Professor of Medicine-Cardiology, Case Western Reserve University (CWRU) School of Medicine, 11100 Euclid Ave, Mailstop LKS 5038, Cleveland, OH 44106. Email: Farshad.Forouzandeh@case.edu