Optical Coherence Tomography Findings of Provoked Coronary Spasms in Patients with Atherosclerotic Vessels

The aim of this case report was to show the dynamics of the wall structure during the spasm. In 2 patients who underwent irst-generation drug-eluting stent implantation, optical coherence tomography (OCT) showed detailed cross-sectional structure of the coronary wall. Segments distal to the implanted stents were observed during spasm provocation by acetylcholine. The patient in case 1, an 82-year-old man, underwent Taxus stent implantation (3.0 × 32 mm and 3.0 × 12 mm) for in-stent restenosis and a new lesion 20 months after bare-metal stent implantation in the distal right coronary artery. Five months later, angina pectoris recurred, and follow-up coronary angiography revealed severe coronary spasm distal to the stents. The patient in case 2, a 69-year-old man, underwent Cypher stent (3 × 28 mm) deployment for a new lesion in the mid-left anterior descending artery. The Cypher stent overlapped with a previously implanted bare-metal stent at the proximal site. Nine months later, he again experienced chest oppression; follow-up coronary angiography revealed severe coronary spasm provocation distal to the stents. In both the cases, as observed using OCT, the vessel diameter decreased, the lumen narrowed, and the intimal and medial layers thickened during the spasm, even in segments with atherosclerosis. Furthermore, the lumen border appeared star shaped.