Continuous intracoronary nitroglycerin infusion for spasm after angioplasty

A patient with reversible coronary artery spasm superimposed on fixed atherosclerotic coronary disease was treated with percutaneous transluminal angioplasty. The procedure successfully dilated the atherosclerotic lesion. However, 20 minutes later, the patient developed coronary artery spasm at the angioplasty site. Sublingual nitroglycerin, sublingual nifedipine, intravenous nitroglycerin, and repeated boluses of intracoronary nitroglycerin alleviated episodes of spasm, but failed to prevent recurrence. The patient was successfully treated with a continuous intracoronary infusion of nitroglycerin. Patients with coronary artery spasm in addition to fixed obstructive coronary disease may be at higher risk for spasm after percutaneous transluminal angioplasty. Continuous intracoronary infusion of nitroglycerin may be an effective therapy for recurrent coronary artery spasm occurring in the catheterization laboratory.