Abstract

In recent years, significant advancements have been made in chronic total occlusion (CTO) percutaneous coronary intervention (PCI), with improvements in the indications, technical aspects, imaging, and complication management of the procedure. Randomized controlled trials and rigorous prospective registries have provided high-quality data regarding the benefits and risks of CTO PCI. Coronary artery spasm is a reversible vasoconstriction that narrows the lumen of normal or atherosclerotic coronary arteries, obstructing myocardial blood flow due to spontaneous vascular smooth muscle hypercontractility and vascular wall hypertension. Coronary artery spasm can present in a variety of clinical scenarios, ranging from asymptomatic events to different types of acute coronary syndromes [unstable angina, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI)] and sudden cardiac death. In our case, a life-threatening malignant coronary vasospasm occurred during the CTO intervention, highlighting the importance of recognizing that this condition may require acute aggressive treatment.