Work

Mechanism-Directed Management of Refractory Vasospasm

Year: 2026

Type: article

Abstract: IMAGE: Serial angiography of pain-associated and cold-associated vasospasm refractory to intra-arterial vasodilators during peripheral endovascular intervention. CASE SUMMARY: Two patients with systemic sclerosis underwent tibial intervention for chronic limb-threatening ischemia and developed diffuse vasospasm beyond the treated segment despite repeated intra-arterial vasodilators. In the first, severe procedural pain preceded vasospasm, which resolved immediately after sciatic nerve blockade. In the second, vasospasm occurred during cold exposure despite sciatic nerve blockade and improved after active limb warming. TAKE-HOME MESSAGE: Vasodilator-resistant vasospasm may arise from mechanisms beyond device manipulation; recognizing pain-associated or cold-associated triggers may guide mechanism-directed management.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.109895

Authors: Katsuyuki Hanabusa, Tatsuya Nakama, Shunsuke Kojima, Yuta Kato, Kotaro Obunai

Institution: Tokyo Bay Urayasu Ichikawa Medical Center

Language: English

Topic: Peripheral Artery Disease Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850