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Objective To investigate the clinical characteristics of patients with coronary artery spasm (CAS) combined with obstructive stenosis and the impact of stent implantation on their prognosis. Methods A retrospective observational study was conducted on patients admitted to Nanjing Jiangbei Hospital from June 2009 to June 2021, diagnosed with coronary artery spasm syndrome (CASS). Based on the results of coronary angiography (CAG), patients were divided into two groups: those combined with obstructive stenosis (n=24) and those without obstructive stenosis (n=20). The efficacy of medical treatment or combined stent implantation was observed, and major adverse cardiovascular events (MACE) or death were monitored during follow-up. Results There were no statistically significant differences between the group CAS combined with obstructive stenosis and the group CAS without obstructive stenosis in terms of gender, age, risk factors (hypertension, diabetes, alcohol abuse, smoking), laboratory test indicators ［peak values of blood glucose (Glu), low-density lipoprotein cholesterol (LDL-C),total cholesterol］, myocardial injury markers ［cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB)］, ejection fraction (EF), and proportion of inferior wall ST segment elevation on electrocardiogram (P>0.05). Among 24 cases of spastic coronary artery complicated with obstructive stenosis, 5 cases (20.83%) were treated with drugs, and 19 cases (79.17%) underwent PCI ［15 cases (78.95%) had PCI on spastic and obstructive stenostic coronary arteries and 4 cases (21.05%) had PCI on non-spastic coronary arteries］. Among 20 cases of spastic coronary artery without stenosis, 16 cases had right coronary artery (RCA)spasm (including 13 cases had RCA completely normal with spasm, 3 cases with 20%-30% stenosis), 4 cases of left anterior descending artery (LAD) spasm (2 cases of completely normal, 2 cases with 30%-40% stenosis), and only 1 case (5.00%) underwent PCI in non-spastic coronary artery. in the group with coronary artery spasm and obstructive stenosis, the follow-up period ranged from 24 to 129 (64.13±29.80) months, with 4 cases of angina recurrence, 1 case of in-stent stenosis, and 1 case of very late stent thrombosis leading to acute myocardial infarction requiring emergency PCI. In the group without stenosis, the follow-up period ranged from 30 to 168 (64.75±32.54) months, with 7 cases of angina recurrence and 1 death. The incidence of MACE (25.00% vs40.00%) was not statistically significant between the two groups (P＞0.05). Conclusion Patients with CAS and obstructive stenosis can choose medical treatment combined with stent implantation for good prognosis, but guidance under intracoronary imaging is necessary.