Coronary stenting in patients with medically resistant vasospasm

Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfidly treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm.