PMC9817490_01
(A) Preoperative multidetector computed tomography showing severe stenosis in the orifice of the left main coronary artery with no evidence of atherosclerotic change (white arrowhead). (B) Preoperative coronary angiography shows severe stenosis of the orifice of the left main coronary artery with no evidence of atherosclerotic change (white arrowhead). (C) Intravascular ultrasound in the non-stenotic area shows normal intima with adequate diameter. (D) Intravascular ultrasound in the stenotic area shows shrinkage of the wall due to thickened inflamed intima.
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Multidetector computed tomography and coronary angiography (Figure 1A,B) revealed severe stenosis of the left main coronary artery orifice with no evidence of atherosclerotic changes. During coronary angiography, intravascular ultrasound showed shrinkage of the wall due to a thickened inflamed intima (Figure 1C,D).
(A) Emergency coronary angiography reveals exacerbation of the severe stenosis in the orifice of the left main coronary artery (white arrowhead). (B) Postoperative urgent coronary angiography demonstrates spastic occlusion of the posterior descending branch (white arrowheads). (C) Postoperative urgent coronary angiography shows released vasospasm after infusion of nitroglycerin and isosorbide dinitrate (white arrowheads).
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After establishing extracorporeal membrane oxygenation, emergency coronary angiography revealed worsening of the previous lesion (Figure 2A). After surgery, urgent coronary angiography demonstrated patent anastomosis of both bypass grafts but diffuse vasospasm of the posterior descending branch (Figure 2B). Because intravascular ultrasound detected the presence of spasm and infusion of vasodilators via both intravenous and coronary artery orifices was not efficient, a microcatheter with small side holes was passed through the posterior descending branch selectively, resulting in effective resolution of the coronary spasm (Figure 2C).
(A) Three-dimensional head computed tomography indicates severe hypoplasia of the left internal carotid artery (dotted black arrow). (B) Carotid angiography shows a champagne bottle-neck sign in the proximal portion of the internal carotid artery (dotted black arrow).
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During further examination for coronary artery lesions during the previous hospitalization, severe hypoplasia of the left internal carotid artery was detected despite the absence of neurological symptoms (Figure 3A). Carotid angiography revealed a so-called champagne bottle-neck sign, which led to speculation that vasospastic occlusion may have caused the hypoplasia (Figure 3B).