# Multiple Intimal Injuries Associated With Severe Coronary Spasm

## TL;DR

This paper describes a case where severe coronary spasm led to multiple intimal injuries and fatal outcomes, highlighting the importance of optical coherence tomography in identifying high-risk patients.

## Contribution

The study identifies a new OCT pattern of multiple intimal injuries associated with severe coronary vasospasm and fatal cardiac events.

## Key findings

- Optical coherence tomography revealed multiple focal intimal injuries and vessel shrinkage in a patient with severe coronary vasospasm.
- The patient experienced recurrent ischemic events and died from nonocclusive mesenteric ischemia despite intensive care.
- Recognition of this OCT pattern may help identify high-risk vasospastic patients requiring aggressive vasodilator therapy.

## Abstract

Coronary vasospasm is a recognized but underappreciated cause of out‐of‐hospital cardiac arrest. However, the intracoronary imaging features associated with life‐threatening vasospastic events have not been fully characterized. We present a patient who experienced recurrent cardiac arrest due to severe coronary vasospasm. Optical coherence tomography (OCT) revealed multiple focal intimal injuries, microthrombus formation, and vessel shrinkage, despite the absence of fixed coronary obstruction. The patient developed repeated ischemic events and ultimately died from nonocclusive mesenteric ischemia despite intensive care. This case illustrates that severe coronary vasospasm can cause repeated intimal injury and trigger fatal cardiac arrest. OCT may help identify a high‐risk vasospastic phenotype that requires heightened clinical vigilance and aggressive vasodilator‐based management.

Multiple coronary intimal injuries detected by optical coherence tomography (OCT) may represent a severe vasospastic phenotype associated with recurrent ischemic events and sudden cardiac arrest. Recognition of this OCT pattern may help identify high‐risk patients who require heightened clinical vigilance and aggressive vasodilator therapy to prevent fatal complications.