Successful treatment of vasospastic angina refractory to various therapies using stenting: A case report

We encountered a case of coronary angina refractory to multiple medications, including a calcium channel blocker, nitroglycerin, fasudil (a Rho kinase inhibitor), left stellate ganglion block, thoracic sympathetic ganglion blockade, steroids, and denopamine. During the course of treatment, ventricular tachycardia (VT) occurred due to ST-segment elevation, and an implantable cardioverter-defibrillator was implanted; however, the patient had recurrent VT. A 12‑lead electrocardiogram showed ST elevation localized to leads II, III, and a Vf, and stenting was performed in all main trunks of the right coronary artery. After stenting, the daily angina attacks stopped, VT disappeared, and the chronic phase was controlled with her existing drug therapy, although she had mild chest pain attacks. There is limited evidence regarding the treatment of refractory angina pectoris. In this case, a patient with coronary angina pectoris refractory to various therapies underwent stenting, and the potentially fatal arrhythmia disappeared.

Learning objective

Management of refractory coronary angina pectoris poses a challenge. Despite attempting conventional therapies, our initial efforts were met with unsuccessful outcomes. Finally, we succeeded in treating the patient with stenting. This case report underscores the challenge of managing refractory coronary angina and explores diverse therapeutic approaches, including conventional medications, sympathetic nerve interventions, and stent placement.