BACKGROUND Most coronary spastic angina patients are responsive to coronary vasodilators therapy, and stent implantation is not recommended for regular use. We reported the angiographic and intravascular ultrasound (IVUS) images of a rare case who responded poorly to medical treatment due to progressive atherosclerotic plaque at the spastic site. CASE PRESENTATION A 60-year-old man complaining of 1-month history of episodic chest pain at rest was admitted to our hospital. The diagnosis of coronary spastic angina was made based on the angiographic evidence of vasospasm at the right coronary artery (RCA). The patient responded poorly to conventional medical treatment during the 1-year follow-up. The repeated angiography revealed totally occlusion of the proximal segment of the RCA at the same location as 1 year before, and IVUS demonstrated there was vulnerable plaque and thrombus at the site of spasm. Episodic chest pain ceased completely in the follow up period after stenting. CONCLUSION Coronary spasm might present at the vessel site with advanced atherosclerotic plaque. For patients with refractory vasospastic angina and significant occlusion, stenting might be a viable and valuable treatment strategy under the guidance of intracoronary imaging.

中文翻译：

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进行性动脉粥样硬化斑块部位冠状动脉痉挛性心绞痛患者的血管内超声检查结果和支架植入，对药物治疗反应差：一例报告。

背景技术大多数冠状痉挛性心绞痛患者对冠状血管扩张剂治疗有反应，并且不建议将支架植入常规使用。我们报道了一个罕见病例的血管造影和血管内超声（IVUS）图像，该病例由于痉挛部位的进行性动脉粥样硬化斑块而对药物治疗反应差。病例介绍一名60岁男子因休息时发作性胸痛病史为1个月而入院。冠状动脉痉挛性心绞痛的诊断是基于右冠状动脉（RCA）血管痉挛的血管造影证据。在1年的随访期间，患者对常规药物的反应较差。重复的血管造影显示，RCA的近端部分完全闭塞在与一年前相同的位置，IVUS证明在痉挛部位有脆弱的斑块和血栓。支架置入术后随访期间，发作性胸痛完全消失。结论冠状动脉痉挛可能在血管部位出现晚期动脉粥样硬化斑块。对于难治性血管痉挛性心绞痛和严重阻塞的患者，在冠状动脉内成像的指导下，支架置入术可能是一种可行且有价值的治疗策略。