Multiple Intimal Injuries Associated With Severe Coronary Spasm

Coronary vasospasm is a recognized but underappreciated cause of out-of-hospital cardiac arrest. However, the intracoronary imaging features associated with life-threatening vasospastic events have not been fully characterized. We present a patient who experienced recurrent cardiac arrest due to severe coronary vasospasm. Optical coherence tomography (OCT) revealed multiple focal intimal injuries, microthrombus formation, and vessel shrinkage, despite the absence of fixed coronary obstruction. The patient developed repeated ischemic events and ultimately died from nonocclusive mesenteric ischemia despite intensive care. This case illustrates that severe coronary vasospasm can cause repeated intimal injury and trigger fatal cardiac arrest. OCT may help identify a high-risk vasospastic phenotype that requires heightened clinical vigilance and aggressive vasodilator-based management.