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 Table of Contents  
CURRICULUM IN CARDIOLOGY - IMAGES
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 233-234

Catheter-induced coronary spasm: A beginner's trap


Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, Haryana, India

Date of Web Publication11-Jan-2019

Correspondence Address:
Dr. Kunal Mahajan
Holy Heart Advanced Cardiac Care and Research Centre, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_58_18

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How to cite this article:
Mahajan K, Batra A, Gupta A, Singla V. Catheter-induced coronary spasm: A beginner's trap. J Pract Cardiovasc Sci 2018;4:233-4

How to cite this URL:
Mahajan K, Batra A, Gupta A, Singla V. Catheter-induced coronary spasm: A beginner's trap. J Pract Cardiovasc Sci [serial online] 2018 [cited 2019 May 19];4:233-4. Available from: http://www.j-pcs.org/text.asp?2018/4/3/233/249940

A 50-year-old male undergoing evaluation for chest pain was subjected to diagnostic coronary angiogram. Transradial coronary angiography was performed. On left coronary artery injection, obstructive disease was noted in the proximal left anterior descending coronary artery, with maximum luminal narrowing of 50% [Figure 1]. Left circumflex coronary artery revealed mild plaques but no significant obstruction [Figure 1]. The operator faced difficulty in hooking the right coronary artery (RCA), and excessive torque was applied which led to the deep seating of the diagnostic catheter. On RCA injection, a tight stenosis was noted in the proximal segment [Figure 2], and this was believed to be the cause of his chest pain. Thus, the patient was subjected to the percutaneous coronary intervention of RCA. However, to our surprise, when we hooked RCA with the guiding catheter, there was no disease in RCA [Figure 3]. We confirmed it on multiple views. Notably, there was no deep hooking of RCA this time when compared to the diagnostic angiography. The stenosis apparent at diagnostic angiography was likely to have been a manifestation of the catheter-induced spasm, which was caused as a result of deep cannulation. Finally, the procedure was abandoned and the patient was saved of an unnecessary intervention.
Figure 1: Left coronary artery injection.

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Figure 2: Right coronary artery injection showing spasm of the proximal right coronary artery. Note the deeply seated diagnostic catheter (black arrow).

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Figure 3: Injection with the guiding catheter showed no disease in the right coronary artery. Note that the catheter was not deeply seated this time.

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Catheter-induced spasm can mostly be prevented by avoiding deep cannulation of the coronary arteries and the use of less aggressive catheters. While catheter-induced spasm is considered to be rare, it needs to be ruled out to avoid unnecessary revascularization.[1] Routine use of intracoronary nitrates in all patients undergoing diagnostic angiography would minimize the confounding effects of vasospasm and enhance reproducibility of coronary measurements.[2]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ali F, Faraz HA, Siddiqui MU. Left main coronary artery spasm – A rare entity as a cause of myocardial infarction in a patient. J Invasive Cardiol 2013;25:E36-8.  Back to cited text no. 1
    
2.
Ilia R, Shimony A, Cafri C, Weinstein JM. Angiographic characteristics of catheter-induced spasm of the left main coronary artery. Am J Cardiol 2016;117:571-3.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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