Introduction: Specific intracoronary findings on coronary vasospasm (CS) using several intracoronary imaging modalities have been reported. It is also documented that the characteristics are different from the types of spasm, focal and diffuse spasm. However there are few data about CS using coronary angiosopy (CAS).
Hypothesis: We hypothesized that there were different morphologic appearances at the CS site depending on spasm type, focal and diffuse spasm. We investigated those specific findings using CAS and optical coherence tomography (OCT).
Methods: We performed CAS and OCT to CS patients who were provoked by acetylcholine. We evaluated coronary plaque, incidence of coronary thrombus with CAS and lumen area, intima area and intima thickness with OCT, and compared the differences within focal and diffuse type of spasm.
Results: Total of 45 CS provoked patients were enrolled. Ten CS patients (mean age 67.9 yeas, 4 male) had focal spasm and 35 patients (mean age 61.1 yeas, 21 male) had diffuse spasm. CAS showed there were more atherosclerotic yellow plaques at the focal spasm site than diffuse spasm, and coronary arteries at the diffuse spasm site were less atherosclerotic and smoother than focal VSA (Figure). Moreover there were more thrombus at the focal spasm site. On the other hand, OCT showed intima area and maximum intima thickness in focal CS group were larger than in diffuse CS group (4.25 ± 0.58 mm2 vs. 2.55 ± 0.22 mm2, P = 0.013; 0.74 ± 0.08 mm vs 0.39 ± 0.06 mm, P = 0.010, respectively). There was no significant difference in lumen area (12.03 ± 3.3 mm2 vs. 8.18 ± 0.76 mm2, P = 0.147) and minimum intima thickness (0.12 ± 0.01 mm vs. 0.11 ± 0.01 mm, P = 0.728) between focal and diffuse CS.
Conclusions: These results indicate that the presence of atherosclerotic plaque at the spasm site is likely to be related to the occurrence of focal vasospasm, although the severity and distribution of the disease did not differ between each patient group.