(187) Refractory Coronary Vasospasms Treated With Stellate Ganglion Block

Introduction: Coronary artery vasospasm (CAS) is a condition that is typically managed by calcium channel blockers and nitrates. Alternatively, pacemaker implantation may be considered in patients with additional complications related to CAS. We present a case of a middle-aged male with refractory CAS despite maximal medical management that was successfully treated with stellate ganglion block (SGB).

Description: A 56-year-old male with a history of cocaine use disorder and recurrent coronary vasospasm was brought in for evaluation of suspected ST-Elevation Myocardial Infarction (STEMI). ECG upon arrival revealed dynamic ECG changes with intermittent ST elevations with spontaneous resolution. The patient was admitted for NSTEMI and was started on Acute Coronary Syndrome protocol with serial ECG monitoring. His course was complicated by multiple cardiac arrests due to ventricular fibrillation. He underwent left heart catheterization that was notable for diffuse coronary spasm without evidence of fixed obstruction which were treated with intracoronary nitroglycerin (ICN) with marked improvement. Despite optimal medical therapy, he continued to have dynamic ST-T wave changes due to refractory coronary spasms. He underwent successful SGB at the left transverse process of the C6 vertebrae with complete resolution of CAS evident by resolution of ST-T wave changes on serial ECGs.

Discussion: CAS are generally treated with calcium channel blockers and nitrates. In patients who undergo cardiac catheterization, application of ICN has a high success rate. In cases where CAS are refractory to standard therapy, treatment options are limited with high mortality rate. Our patient had refractory CAS despite maximal medical therapy and was successfully treated with SGB. Data regarding successful management of refractory CAS with SGB is limited, with fewer than five cases reported in the literature, reflecting a need for further research as a potential treatment option in refractory cases.

Disclaimer: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.