In conclusion, we examined small-sized platelet aggregates at baseline and after spontaneous coronary spastic attacks in patients with coronary spastic angina, and before and after anginal attacks during an exercise test in patients with stable exertional angina. The number of small-sized platelet aggregates after coronary spastic anginal attacks increased significantly, but not in patients with stable exertional angina. These results imply that an increase in the number of small-sized platelet aggregates from coronary spasm may be a trigger for coronary thrombus via medium- and large-sized platelet aggregates.