Variant angina arises from coronary artery spasm (CAS). Standard treatment controls the condition in most patients. In a small subset, however, that treatment is either insufficient to achieve adequate control or cannot be tolerated — requiring an evidence-based step-up to alternative management.
For refractory CAS, the alternative approach draws from several pharmacological classes — including anti-adrenergic agents — as well as a range of interventional and surgical options reserved for appropriate candidates. Which agents apply, in what order, and when to escalate to procedural management are specified in the full structured protocol.
Specific agents, eligibility criteria, sequencing, and procedural indications are detailed in the complete regimen.