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asospastic angina can be diagnosed by several established provocation tests,1 including intracoronary acetylcholine (ACH) injection2 and the ergonovine loading test, during cardiac catheterization. These methods are also popular for evaluating local “endothelial function” where drug-eluting stents3 have been implanted.4 However, we do not fully understand the phenomenon of vasospastic angina because actual vessel behavior at the exact moment of spasm has rarely been visualized. Here, we report the management of a 72-year-old man with vasospastic angina refractory to maximum-dose pharmacological treatment. The patient also suffered drug-induced eruptions, most likely caused by calcium antagonists. Although coronary intervention for a spastic segment without high-grade luminal stenosis is regarded as harmful (Class III) according to the Japanese Circulation Society Guideline 2008,5 we concluded that we had no better alternative for this patient than the placement of a bare metal stent at the major spastic segment. It seemed the only way to diminish the spastic attacks as well as reducing the dose or stopping altogether the drugs suspected of causing the side effects. The exact location where the stent should be placed was determined by repeated ACH provocation tests. Written informed consent for these procedures was given by the patient in advance. Detailed

Serial Intravascular Ultrasound Observation of the Behavior of Coronary Artery During a Positive Spasm Provocation Test