Fifteen coronary angiograms, nine stents, and surgical denervation: unresolved vasospastic angina in a young patient—a case report

Introduction Vasospastic angina (VSA) can mimic obstructive coronary disease and may lead to overtreatment. Case presentation A middle-aged Caucasian man with recurrent chest pain underwent stenting and escalating therapy despite negative angiograms. Subsequent provocative testing confirmed a diagnosis of refractory VSA. Although autonomic modulation improved symptoms, recurrence of symptoms suggested persistent endothelial dysfunction and complex pain mechanisms. Conclusion This case underscores the importance of early functional testing to prevent unnecessary interventions and support a tailored, holistic approach to the management of VSA.