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We describe a 50-year-old man with rest angina and ECG anteriorwall subendocardial ischemia. During coronary angiography, ahigh-grade proximal left anterior descending stenosis was present.Spontaneous total spasm distal to the lesion occurred withoutchest pain or ST segment shifts. The patient underwent aortocoronarybypass surgery and continued to have the same pain as preoperatively.Repeated catheterization demonstrated total occlusion of thebypass graft with unchanged native coronary vessels. This suggestsprolonged coronary artery spasm as the mechanism for graft occlusion.
