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(Circulation. 1998;98:822.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Vasoconstriction After Coronary Stenting

Michael A. Kjelsberg, MD; Michael E. Cothern, PA-C, MHP; ; Campbell Rogers, MD

From the Department of Medicine (Cardiac Catheterization Laboratory, Cardiovascular Division, Brigham and Women's Hospital), Harvard Medical School, Boston, Mass (M.A.K., M.E.C., C.R.), and the Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge (M.A.K., C.R.).

Correspondence to Campbell Rogers, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail cdrogers@bics.bwh.harvard.edu

An 83-year-old woman was transferred to Brigham and Women's Hospital with postinfarction angina and cardiogenic shock 24 hours after thrombolytic therapy for an inferior myocardial infarction. Coronary angiography showed a 90% stenosis in a dominant right coronary artery (Figure). She underwent successful percutaneous coronary angioplasty, including deployment of an articulated Palmaz-Schatz stent, leaving no residual stenosis. Six hours later, she developed hypotension and was treated with an intravenous infusion of dopamine. Repeat angiography demonstrated a patent vessel, with marked coronary vasoconstriction evident throughout, sparing only the stented segment. This case demonstrates that coronary stents can withstand vasoconstriction, which may lessen the incidence of abrupt vessel closure after coronary angioplasty for acute myocardial infarction. She recovered uneventfully and was discharged home on hospital day 15.

View larger version (76K): [in this window] [in a new window]   Figure 1. A, Coronary arteriogram shows a 90% stenosis (arrow) in right coronary artery. B, Immediately after deployment of an articulated Palmaz-Schatz stent (between arrows), no residual stenosis is seen. C, During dopamine infusion with diffuse coronary artery vasoconstriction, the stent (straight arrows) remains patent aside from spasm evident at the central articulation site (curved arrow). Quantitative analysis with electronic calipers showed a 50% loss of lumen diameter throughout the vessel and 0% loss in the stented segment.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images . . . [Full Text of this Article]