Abstract
Coronary artery spasm is a known cause of acute coronary syndrome. However, left main
coronary spasm is an extremely rare entity and can present in different ways depending
on the duration and severity of the spasm. We present a 44-year-old female patient
who presented with transient ST elevation in the lead aVR and ST depression in the
lateral and inferior leads. Coronary angiography showed mid left main and ostial right
coronary artery spasm that significantly improved after intracoronary nitroglycerine
administration. Intravascular ultrasound showed no significant left main coronary
atherosclerosis. She was treated chronically with calcium channel blockers (CCB),
nitrates, and arginine with significant improvement. In conclusion, left main coronary
spasm is an extremely rare entity with wide spectrum of clinical manifestations. Definite
etiology is still questionable, and special precaution is needed during coronary angiography
in order not to be confused with significant fixed lesions. Intravascular ultrasound
can be valuable in excluding underlying atherosclerosis. Medical management with nitrates
acutely then CCB is the mainstay of chronic management with PCI preserved to refractory
cases.
Keywords
coronary intervention - left main coronary artery spasm - acute coronary syndrome
- ischemia - cardiac catheterization - intravascular ultrasound
