Coronary artery spasm associated with a moderately severe atherosclerotic stenosis in the proximal LAD

Treatment of coronary artery spasm can be difficult; up to 25% of patients continue to have episodes of chest pain despite maximal therapy with calcium antagonists and nitrates. We describe the case of a 42-year-old female with severe coronary artery spasm associated with a moderately severe atherosclerotic stenosis of the proximal left anterior descending coronary artery. We discuss the diagnostic value of intravascular ultrasound and treatment options for spasm associated with atherosclerotic plaques.