A Rare Case of Vasospasm Presenting with Acute Coronary Syndrome and Leading to Total Occlusion

Coronary vasospasm is characterized by transient and reversible vasoconstriction that can cause myocardial ischemia. Acute coronary syndrome (ACS) may present to the emergency department with various clinical features, including mortal arrhythmias and cardiac arrest. Coronary angiography (CAG) was performed in a 61-year-old male patient with the diagnosis of ACS due to recurrent angina attacks and dynamic changes in electrocardiography (ECG). In the patient whose critical stenosis was not detected in the first imaging, angina attack developed before the procedure was terminated. On control imaging, we detected total occlusion of the left anterior descending (LAD) artery due to coronary vasospasm. After the administration of intracoronary nitroglycerin, the total occlusion of the LAD artery due to vasospasm completely resolved and the angina attack resolved. It is rare to develop total stenosis immediately after an opening in the coronary arteries is observed during the CAG procedure. However, if total stenosis is detected in patients with recurrent angina attacks without risk factors, intracoronary nitroglycerin can be administered to appropriate patients before intervention.