Arteriographic Demonstration of Coronary Artery Spasm during Thrombolysis

A 60-year-old man with an acute inferior-wall myocardial infarction was noted, on arteriography, to have an occluded distal right coronary artery. The vessel was reopened with intravenous tissue plasminogen activator; during resolution of the clot, spasm was observed arteriographically but was successfully treated with intracoronary nitroglycerin. Follow-up arteriography showed a normal right coronary artery. The significance of this case lies in the fact that we were able to document the occurrence of spasm during coronary thrombolysis; such documentation supports the hypothesis that spasm may be a factor in the initiation of coronary thrombosis.