Cocaine-Induced Coronary Vasospasm Using Optical Coherence Tomography Imaging to Guide Management
A 47-year-old male smoker presented with an inferior ST-segment myocardial infarction (STEMI) 4 h after taking cocaine. Emergency coronary angiography demonstrated a large-caliber proximally occluded right coronary artery ( Figure 1A ) and similarly large smooth left coronary arteries. Aspiration thrombectomy was performed, directly via the guide catheter, and large volumes of red thrombus were removed ( Figure 1B ). Flow was restored, revealing a tight proximal stenosis ( Figure 1C ) that, after administration of copious intracoronary nitrates, completely resolved, suggesting cocaine-induced vasospasm ( Figure 1D ).
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