Internal mammary revascularization in patients with variant angina and normal coronary arteries

Patients with variant angina refractory to medical therapy pose a difficult management problem. In patients with discrete obstructive lesions, coronary revascularization may be helpful. However, it has been widely accepted that coronary revascularization is contraindicated in patients with isolated coronary spasm without evidence of obstructive disease. Here we describe the two patients with life-threatening, medically intractable Prinzmetal's angina and angiographically normal coronary arteries, both of whom underwent coronary-artery-bypass surgery with the internal-mammary-artery (IMA) graft. These operations resulted in rapid, complete remission of coronary spastic attacks in both patients. Postoperative angiography reveals how the IMA graft works during spastic attacks.