Abstract
Background: Despite significant interest in intracoronary thrombi in patients with vasospastic angina (VSA), the phenomenon remains unclarified. Therefore, we investigated a possible relationship using coronary angioscopy (CAS) in VSA patients. Methods: Sixty patients with VSA, for whom we could assess the spastic segment using CAS, were retrospectively studied. An intracoronary thrombus on CAS was a white thrombus and an erosion-like red thrombus. We verified the clinical characteristics and lesional characteristics as they determined the risk of intracoronary thrombus formation. Results: There were 18 (30%) patients with intracoronary thrombi. More of the patients with intracoronary thrombi were male, current smokers and had severe concomitant symptoms; however, no statistically significant difference was observed upon logistic regression analysis. There were 18 (26%) coronary arteries with intracoronary thrombi out of 70 coronary arteries recognised in the spastic segments. Furthermore, atherosclerotic changes and segmental spasms were significant factors responsible for such lesions. Conclusion: Intracoronary thrombi occurred in 30% of VSA patients and much attention should be paid to the intracoronary thrombogenicity of VSA patients.
Highlights
Coronary spasm is characterised by transient vasoconstriction of the epicardial coronary artery, leading to myocardial ischaemia [1,2,3]
Among the total 72 patients who underwent coronary angioscopy (CAS) study, one patient (1%) had a recurring coronary spasm during a CAS study because the proving catheter might stimulate the coronary artery at the myocardial bridge segment
The coronary spasm had been relieved by an intracoronary administration of NTG after a prompt observation of CAS
Summary
Coronary spasm is characterised by transient vasoconstriction of the epicardial coronary artery, leading to myocardial ischaemia [1,2,3]. Regarding the relationship between coronary spasm and ACS or MINOCA, much attention has been paid to the frequency of intracoronary thrombus formation in patients with vasospastic angina (VSA). Many studies have investigated the relationship between intracoronary thrombus formation and coronary spasm using intracoronary imaging techniques that show intracoronary thrombi in patients with VSA [10,11,12,13,14]. The assessment using IVUS or OCT could help determine the frequency of intracoronary thrombus formation in VSA patients, based on detailed observations of the entire circumference of the coronary artery and the whole of the coronary artery from the distal to proximal segments, especially in high-definition IVUS or OCT due to the high resolution of images. Conclusion: Intracoronary thrombi occurred in 30% of VSA patients and much attention should be paid to the intracoronary thrombogenicity of VSA patients
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