# Acute myocardial infarction caused by vasospasm of a jailed diagonal branch subsequent to stent implantation in the left anterior descending artery: a case report

## TL;DR

A 67-year-old woman developed a heart attack due to a spasm in a blood vessel jailed by a stent, highlighting a rare complication of stent implantation.

## Contribution

This is the first reported case of acute myocardial infarction caused by vasospasm in a stent-jailed diagonal branch.

## Key findings

- Acetylcholine provocation test confirmed vasospasm in the jailed diagonal branch.
- A second stent implantation resolved the patient's chest pain.
- Stent edges may promote vasospasm in jailed side branches due to endothelial dysfunction.

## Abstract

Coronary stents have been reported to cause endothelial dysfunction, potentially leading to spasm at the edges of the stent. However, the clinical significance of vascular spasm in stent-jailed side branches remains poorly understood.

A 67-year-old woman was referred to our hospital for angina occurring both during exercise and at rest. An everolimus-eluting stent was implanted for a physiologically significant stenosis in the proximal left anterior descending artery, while an intermediate stenosis persisted in the jailed first diagonal branch. Although her exertional angina resolved, her rest symptoms worsened after percutaneous coronary intervention (PCI). She was admitted with acute myocardial infarction 1 month later. Urgent coronary angiography showed no stent failure, but an acetylcholine provocation test induced a spasm leading to total occlusion of the jailed diagonal branch. An additional stent was implanted in the diagonal branch due to a residual stenosis even after isosorbide dinitrate administration. After the second PCI, her chest pain completely resolved.

This is the first documentation of aggregated coronary spasm observed at the ostium of stent-jailed side branch. Stent implantation may induce endothelial dysfunction and promote inflammation, leading to spasms particularly at stent edges. This phenomenon can extend to side branches jailed by the stent, and invasive intervention may be a viable therapeutic strategy for such cases.