Angiographic and Pathologic Correlations in Prinzmetal Variant Angina

Abstract

The coronary-arteriographic and pathologic findings in a case of Prinz metal's angina are reported. Right coro nary arteriograms performed in the ab sence of pain showed only minor stenotic changes, whereas those performed dur ing an anginal attack revealed a spastic occlusion involving almost the entire vessel. Anatomic examination revealed obstructive lesions of the right coronary artery, more pronounced at the site where spasm had started, due to con centric atherosclerotic thickening of the inner wall, whereas the elastic fibers and the muscular ring of the tunica media were preserved.

These findings suggest (1) the need for great caution before assuming on purely angiographic bases that spasm may af fect a normal coronary artery and (2) the possibility that spasm occurs in a markedly diseased and stenotic segment of a coronary artery as long as the con tractile tissue of the tunica media is pre served.