{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:05:04Z","timestamp":1771225504497,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary artery vasospasm following coronary artery bypass grafting (CABG) is a rare but potentially life\u2010threatening complication that can lead to myocardial ischemia, arrhythmias, and cardiogenic shock. Nitroglycerin\u2010resistant vasospasm, particularly involving the left main coronary artery (LMCA), poses significant diagnostic and therapeutic challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report the case of a 47\u2010year\u2010old female with a history of hypertension, hyperlipidemia, and ADHD on dextroamphetamine\u2010amphetamine, who presented with chest pain and was found to have a suspected severe LMCA lesion. Coronary angiography revealed a 95% LMCA stenosis that was unresponsive to intracoronary nitroglycerin, raising concern for catheter\u2010induced vasospasm versus true stenosis. The patient underwent urgent CABG. Intraoperatively and postoperatively, she experienced recurrent, diffuse coronary vasospasm refractory to nitroglycerin, necessitating multiple interventions including mechanical circulatory support with intra\u2010aortic balloon pump and percutaneous ventricular assist device. Coronary angiography confirmed severe diffuse coronary and peripheral vasospasm. The patient was managed with intravenous vasodilators, vasopressors, and supportive care, and eventually recovered with restoration of cardiac function and discharge to cardiac rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case underscores the difficulty in differentiating vasospasm from true atherosclerotic disease in the LMCA, the potential for nitroglycerin resistance, and the risk of severe complications during CABG. The use of adjunctive imaging modalities, vasodilators beyond nitroglycerin, and early mechanical circulatory support may be critical in managing such complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nitroglycerin\u2010resistant coronary vasospasm, especially in the LMCA, can mimic fixed stenosis and lead to inappropriate surgical intervention and life\u2010threatening complications. A multidisciplinary, imaging\u2010guided approach is essential for accurate diagnosis and optimal management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.31584","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T08:19:29Z","timestamp":1747037969000},"page":"557-562","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Case of Nitroglycerin Resistant Coronary Arterial Vasospasm During Coronary Artery Bypass Surgery"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9489-7641","authenticated-orcid":false,"given":"Dina","family":"Soliman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Castillo\u2010Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Cruz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Abdelmalek","sequence":"additional","affiliation":[{"name":"Division of Cardiology Texas Tech University Health Sciences Center Lubbock Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198105213042101"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.04.063"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.004255"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.09.071"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197304122881511"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)37799-2"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.08.015"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-012-0201-5"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)65869-9"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)61133-2"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.09.078"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-019-0876-0"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22462"},{"issue":"2","key":"e_1_2_10_16_1","first-page":"107","article-title":"Catheter\u2010Induced Coronary Spasm\u2014A View of Mechanical Factors and Experience With Selective Left Coronary Arteriography","volume":"63","author":"Chang K. S.","year":"2000","journal-title":"Zhonghua Yi Xue Za Zhi = Chinese Medical Journal; Free China ed"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.10.048"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(00)02001-4"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01341-7"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(80)90080-6"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31584","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.31584","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31584","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:08:47Z","timestamp":1771222127000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.31584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ccd.31584"],"URL":"https:\/\/doi.org\/10.1002\/ccd.31584","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]},"assertion":[{"value":"2025-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}