Coronary atherosclerosis and vasospastic angina as combined causes of myocardial ischemia: contemporary invasive diagnostics and percutaneous therapy
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https://orcid.org/0000-0002-8133-9318
Abstract
Coronary artery disease has traditionally been viewed through the prism of anatomical vessel narrowing; however, modern data indicate the critical role of functional disorders, particularly coronary vasospasm. The combination of atherosclerotic stenosis and vasospastic angina represents a dangerous phenomenon that significantly worsens patient prognosis and requires a personalized approach to treatment. The article presents a clinical case in which standard coronary angiography was supplemented with comprehensive physiological assessment for precise endotyping of the causes of ischemia. Measurement of fractional flow reserve (FFR) confirmed the hemodynamic significance of the stenosis, and an acetylcholine provocation test revealed severe epicardial spasm. Considering the mixed mechanism of ischemia, a revascularization strategy without stent implantation was chosen to preserve the vessel’s vasomotor function, specifically the application of a cytostatic agent using a drug-coated balloon (DCB). This clinical case demonstrates the necessity of implementing invasive functional tests (FFR and acetylcholine test) into routine practice to detect combined forms of ischemia and confirms their relevance in modern cardiology practice.
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References
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