Dynamic Coronary Thrombosis: A Possible Cause of Prinzmetal's Variant Angina

Two patients presented with features typical of Prinzmetal's variant angina: recurrent episodes of chest discomfort at rest associated with transient ST segment elevation. Episodes of recurrent ischemia persisted despite treatment with intravenous nitroglycerin. Coronary arteriography disclosed a high grade stenotic lesion and intracoronary thrombus in both patients. Coronary spasm was not demonstrated. These observations suggest that “dynamic thrombosis” may have a more important role than heretofore recognized in some patients with Prinzmetal's variant angina.