(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{at}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.
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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.
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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 to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
