Case of Coronary Artery Spasm With Fatal Outcome in the Early Period After Percutaneous Transluminal Coronary Angioplasty of the Right Coronary Artery With Implantation of Bare Metal Stents

The paper presents a clinical case of coronary artery spasm after implantation of bare metal stents. The 60-year-old man was admitted to the hospital with the progression of the coronary heart disease and high angina pectoris functional class for coronary angiography. The patient had the main predisposing factor for the development of coronary artery spasm, which is 20-year smoking history. Based on the results of the coronary angiography, the decision was made to conduct endovascular treatment. The patient was discharged on the 2 nd day after angioplasty with implantation of two stents in the right coronary artery. On the evening of discharge, the man developed a severe pain attack in the epigastric region and turned to the hospital. The electrocardiogram revealed ST-segment elevation in leads II, III, aVF, T-waves were negative in leads I, aVL and V3-6. Repeat coronary angiography showed the stent implantation sites were passable, there was a pronounced diffuse coronary artery spasm, which could not be eliminated by intracoronary administration of nitroglycerin. Coronary artery spasm induced by coronary angioplasty with stent placement is a rare complication that can develop at different time intervals after endovascular intervention. Based on the presented clinical case, it appears likely that even after bare metal stents implantation, the development of endovascular dysfunction leading to coronary spasm is possible.