Intravascular ultrasound findings and stent implantation for a patient with coronary spastic angina at site of progressive atherosclerotic plaque and responded poorly to medical treatment: a case report

BACKGROUND: Most coronary spastic angina patients are responsive to coronary vasodilators therapy, and stent implantation is not recommended for regular use. We reported the angiographic and intravascular ultrasound (IVUS) images of a rare case who responded poorly to medical treatment due to progressive atherosclerotic plaque at the spastic site. CASE PRESENTATION: A 60-year-old man complaining of 1-month history of episodic chest pain at rest was admitted to our hospital. The diagnosis of coronary spastic angina was made based on the angiographic evidence of vasospasm at the right coronary artery (RCA). The patient responded poorly to conventional medical treatment during the 1-year follow-up. The repeated angiography revealed totally occlusion of the proximal segment of the RCA at the same location as 1 year before, and IVUS demonstrated there was vulnerable plaque and thrombus at the site of spasm. Episodic chest pain ceased completely in the follow up period after stenting. CONCLUSION: Coronary spasm might present at the vessel site with advanced atherosclerotic plaque. For patients with refractory vasospastic angina and significant occlusion, stenting might be a viable and valuable treatment strategy under the guidance of intracoronary imaging.