Prinzmetal, or variant, angina is an unusual syndrome of cardiac pain, which is secondary to myocardial ischemia resulting from transient increases in coronary vasomotor tone or vasospasm. We experienced a 58-year-old male patient with an unusual ST segment using carotid sinus massage during neck surgery. A coronary angiography, with intravenous ergonovine provocation, showed a reversible coronary artery spasm with typical chest pain and ST segment elevation. This is a report of coronary vasospasm detected during neck surgery, and suggests the role of a dynamic sequential change in autonomic function as a key player in the mechanism behind coronary vasospasm.