Disappearance of subocclusive ostial stenosis of the left anterior descending artery

To the Editor

In a recent issue of HERZ, Dodic and colleagues described the phenomenon of complete disappearance of a subocclusive ostial stenosis of the left anterior descending (LAD) artery [1].

This interesting case report raises some questions: Because neither the computed tomographic coronary angiography, performed in 2012, nor the former coronary angiogram, done in 2004, showed significant calcification at the LAD ostium, it would be interesting to know:

• a. Whether in 2004 a second angiogram was done after administration of intracoronary nitroglycerine to rule out coronary spasm

• b. Whether in 2012 intravenous ultrasound or optical coherence tomography was performed to examine the vascular anatomy in the area of the former stenosis.

Sustained coronary artery spasm—although rare—is known to mimic obstructive coronary artery disease [2] as well as being a potential pitfall for inadvertent coronary artery bypass grafting [3].

Tomislav Miljak, MD, MBA