Vascular Damage and Thrombosis from Spasm

To the Editor: In the article, “Coronary-Artery Spasm” in the September 28, 1978, issue of the Journal, Hillis and Braunwald emphasized the evidence implicating coronary vasospasm not only as the principal cause of Prinzmetal's variant angina but also as a possible contributory factor to classic angina pectoris and acute myocardial infarction. It is generally assumed that the threat posed by coronary-artery spasm depends on the degree to which the reduction in transluminal diameter interferes with coronary blood flow. However, there is evidence, derived from recent studies of experimental cerebral vasospasm,¹ that coronary vasospasm may result in myocardial ischemia through.