Vasoconstriction After Coronary Stenting
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.
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.
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