Key result
Intravascular ultrasound demonstrated that luminal dilatation following isosorbide dinitrate administration in a patient with vasospasm-induced acute myocardial infarction was achieved through the redistribution of intima and media volume.
Case Report (n=1)
No
This case report demonstrates via IVUS that acute myocardial infarction can be induced by coronary vasospasm, characterized by reversible diffuse intima plus media thickening without plaque rupture.
Supports reversible intima-media redistribution as AMI mechanism in spasm; hypothesis-generating, requires prospective confirmation before practice implications.
A 53-year-old male complaining of chest pain was admitted to our hospital with suspected acute myocardial infarction (AMI). Emergent coronary angiography (CAG) determined a totally occluded middle right coronary artery (RCA). Thrombus aspiration was conducted, followed by intravascular ultrasound (IVUS) imaging. Diffuse intima plus media thickness was identified at the obstruction site and a thrombus was observed proximally to the occlusion site on IVUS. Following isosorbide dinitrate (ISDN) administration, dilatation of the RCA was confirmed. IVUS study indicated the luminal dilatation was achieved by the release of the diffuse intima plus media thickening. Of note, plaque volume showed no significant difference after administration of ISDN at any vessel site. These results clearly show that luminal dilatation and vessel dilatation were achieved from the redistribution of plaque volume (intima plus media). A follow-up CAG showed no significant stenosis in the RCA. After a provocation test using methylergometrine maleate, the RCA was totally occluded at the very site of the initial event. The involvement of vasospasm as a cause of AMI in the present case was doubly confirmed with characteristic IVUS images of vasospasm in the acute phase and with a provocation test at follow-up.
No takes yet. Share an insight, caveat, or question.
Ota et al. (2013) conducted a case report in Acute Myocardial Infarction induced by coronary spasm (n=1). Isosorbide dinitrate (ISDN) and Intravascular ultrasound (IVUS) was evaluated. Intravascular ultrasound demonstrated that luminal dilatation following isosorbide dinitrate administration in a patient with vasospasm-induced acute myocardial infarction was achieved through the redistribution of intima and media volume.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: