A case of an unstable angina pectoris which was repeated stent thrombosis 3 times and was needed bypass grafting finally
症例は, 58歳, 男性. 2010年7月中旬に胸痛が持続するため, 当院紹介受診となる. 緊急冠動脈造影を施行したところ左前下行枝(#7)90％狭窄を認めたため, そのまま冠動脈インターベンションを施行した. ステント留置(Xience VTM)後より造影遅延となり, ステントストラットからのプラークの逸脱を認めた. ニコランジルの冠動脈内投与後, 大動脈内バルーン·パンピング(intra aortic balloon pumping; IABP)を挿入して終了した. 翌朝, 胸痛が増強したため, 再度冠動脈造影を施行したところ, ステント内プラーク逸脱の増量を認めた. バルーンにて再三圧排...
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| Published in | Shinzo Vol. 44; no. 2; pp. 182 - 189 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
2012
公益財団法人 日本心臓財団 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.44.182 |
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| Abstract | 症例は, 58歳, 男性. 2010年7月中旬に胸痛が持続するため, 当院紹介受診となる. 緊急冠動脈造影を施行したところ左前下行枝(#7)90％狭窄を認めたため, そのまま冠動脈インターベンションを施行した. ステント留置(Xience VTM)後より造影遅延となり, ステントストラットからのプラークの逸脱を認めた. ニコランジルの冠動脈内投与後, 大動脈内バルーン·パンピング(intra aortic balloon pumping; IABP)を挿入して終了した. 翌朝, 胸痛が増強したため, 再度冠動脈造影を施行したところ, ステント内プラーク逸脱の増量を認めた. バルーンにて再三圧排するも拡張不十分のため, Xience VTMよりもストラットが密なCypherTMを追加留置. 良好な拡張を得て終了した. 第3病日にIABPを離脱し, 順調に経過していたが第9病日朝, 冷汗を伴う胸痛があり緊急造影施行. 左前下行枝ステント内で血栓性閉塞を認めた. 血栓を吸引後, バルーンで高圧拡張しDriverTMを留置した. IABPを挿入後, 持続静脈内投与をヘパリンナトリウムからアルガトロバンに変更し, 内服薬はアスピリン, クロピドグレルにシロスタゾールを追加した. 第11病日にIABPから離脱した. 第18病日午前に再度胸痛を認めたため, 緊急造影したところステント内亜急性再閉塞を認めた. バルーンでステント内を高圧拡張しIABPを挿入した. その直後にも胸痛を認め再造影したところ再度血栓性閉塞となっており, 再バルーンニング施行. 提携病院に転院のうえ, 第20病日に準緊急1枝バイパス手術(左前下行枝—左内胸動脈)を施行した. |
|---|---|
| AbstractList | 症例は, 58歳, 男性. 2010年7月中旬に胸痛が持続するため, 当院紹介受診となる. 緊急冠動脈造影を施行したところ左前下行枝(#7)90％狭窄を認めたため, そのまま冠動脈インターベンションを施行した. ステント留置(Xience VTM)後より造影遅延となり, ステントストラットからのプラークの逸脱を認めた. ニコランジルの冠動脈内投与後, 大動脈内バルーン·パンピング(intra aortic balloon pumping; IABP)を挿入して終了した. 翌朝, 胸痛が増強したため, 再度冠動脈造影を施行したところ, ステント内プラーク逸脱の増量を認めた. バルーンにて再三圧排するも拡張不十分のため, Xience VTMよりもストラットが密なCypherTMを追加留置. 良好な拡張を得て終了した. 第3病日にIABPを離脱し, 順調に経過していたが第9病日朝, 冷汗を伴う胸痛があり緊急造影施行. 左前下行枝ステント内で血栓性閉塞を認めた. 血栓を吸引後, バルーンで高圧拡張しDriverTMを留置した. IABPを挿入後, 持続静脈内投与をヘパリンナトリウムからアルガトロバンに変更し, 内服薬はアスピリン, クロピドグレルにシロスタゾールを追加した. 第11病日にIABPから離脱した. 第18病日午前に再度胸痛を認めたため, 緊急造影したところステント内亜急性再閉塞を認めた. バルーンでステント内を高圧拡張しIABPを挿入した. その直後にも胸痛を認め再造影したところ再度血栓性閉塞となっており, 再バルーンニング施行. 提携病院に転院のうえ, 第20病日に準緊急1枝バイパス手術(左前下行枝—左内胸動脈)を施行した. |
| Author | Zinbu, Yumi Abe, Hideki Yaginuma, Genya Uemura, Nao Kawashima, Osamu Mitsuoka, Mikio Aono, Gou |
| Author_FL | 柳沼 厳弥 上村 直 神部 裕美 川島 理 青野 豪 阿部 秀樹 密岡 幹夫 |
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| References | 9) Mourice MC, Serrys PW, Sousa JE, et al: A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002; 346: 1773-1780 24) Juhan-Vague I, Thompson SG, Jespersen J: Involvement of the hemostatic sysytem in the insulin resistnce syndrome: a study of 1500 patients with angina pectoris. Arterioscler Thromb 1993; 13: 1865-1873 3) George BS, Voorhees WD III, Roubin GS, et al: Multicenter investigation of coronary stenting to treat acute or threatened closure after percuaneous transluminal coronary angioplasty: Clinical and angiographic outcomes. J Am Coll Cardiol 1993; 22: 135-143 1) Cutlip DE, Baim DS, Ho K, et al: Stent thrombosis in the modern era a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103: 1967-1971 16) Okabe T, Mintz GS, Buch AN, et al: Intravascular ultrasound parameters associated with stent thrombosis after drug-eluting stent deployment. Am J Cardiol 2007; 100: 615-620 15) Fujii K, Carlier SG, Mintz GS, et al: Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation. An intravascular study. J Am Coll Cardiol 2005; 45: 995-998 10) Moses JW, Leon MB, Pompa JJ, et al: Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315-1323 6) Fischerman DL, Leon MB, Baim DS, et al: A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Ned 1994; 331: 496-501 4) Schatz RA: A view of intravascular stents. Circulation 1989; 79: 445-457 19) Fukuuchi Y, Tohgi H, Okudera T, et al: A randomized, double-blind study comparing the safety and efficacy of clopidogrel versus ticlopidine in Japanese patients with noncardioembolic cerebral infarction. Cerebrovasc Dis 2008; 25: 40-49 21) Desta Z, Zhao X, Shin JG, et al: Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet 2002; 41: 913-958 26) Honda Y, Fitzgerald PJ: Stent thrombosis: an issue revisited in a changing world. Circulation 2003; 108: 2-5 7) Mehta RH, Harjai KJ, Cox DA, et al: Comparison of coronary stenting versus conventional balloon angioplasty on five year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2005; 96: 901-906 13) Cheneau E, Leborgne L, Mintz GS, et al: Predictors of subacute stent thrombosis: results of a systemic intravascular ultra sound study. Circulation 2003; 1108: 43-47 20) Hulot JS, Bura A, Villard E, et al: CytochromeP450 2C19 loss-of-function polymorphism is a major determinent of clopidogrel responsiviness in healthy subjects. Blood 2006; 108: 2244-2247 23) Reaven GM: Role of insulin resistance in human disease. Diabetes 1983; 37: 1595-1600 22) Matetzky S, Shenkman B, Guetta V, et al: Clopidogrel Resistance Is Associated With Increased Risk of Recurrent Atherothrombotic Events in Patients With Acute Myocardial Infarction. Circulation 2004; 109: 3171-3175 2) Schuhlen H, Kastrati A, Pache J, et al: Incidence of thrombotic occlusion and major cardiac events between two and four weeks after coronary stent placement: analysis of 5678 patients with a four-week ticlopiridine regimen. J Am Coll Cardiol 2001; 37: 2066-2073 8) Grines CL, Stone GW, Morice MC, et al: Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999; 341: 1949-1956 12) Mousa I, Mario CD, Reimers B, et al: Subacute Stent Thrombosis in the Era of Intravascular Ultrasound-Guided Coronary Stenting Without Anticoagulation: Frequency, Predictors and Clinical Outcome. J AM Coll Cardiol 1997; 29: 6-12 25) Chieffo A, Bonizzoni E, Orlic D, et al: Intraprocedual Stent Thrombosis During Implantation of Sirolimus-Eluting Stents. Circulation 2004; 109: 2732-2736 11) Iakovou I, Schmidt T, Bonizzoni E, et al: Incidence, predictor, and outcome of thromnosis after successful implantation of drug-eluting stents. JAMA 2005; 293: 2126-2130 14) Ponde CK, Aroney CN, McEniery PT, et al: Plaque prolapse between the struts of the intracoronary Palmaz-Schatz stent: report of two cases with a novel treatment of this unusual problem. Cathet Cardiovasc Diagn 2003; 40: 353-357 5) Serruys PW, de Jaegere P, Kiemeneij F, et al: A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994; 331: 489-495 17) Dural N, Lunven C, Obrien DP: Antithrombotic actions of the thrombin inhibitor, argatroban, in acanine model of the coronary cycle flow: comparison with heparin. Br J Pharmacol 1996; 118: 727-733 27) Lemesle G, Delhaye C, Bonello L, et al: Stent thrombosis in 2008: definition, predictors, prognosis and treatment. Arch Cardiovasc Dis 2008; 101: 769-777 18) Colombo A, Hall P, Nakamura S, et al: Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91: 1676-1688 |
| References_xml | – reference: 17) Dural N, Lunven C, Obrien DP: Antithrombotic actions of the thrombin inhibitor, argatroban, in acanine model of the coronary cycle flow: comparison with heparin. Br J Pharmacol 1996; 118: 727-733 – reference: 8) Grines CL, Stone GW, Morice MC, et al: Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999; 341: 1949-1956 – reference: 18) Colombo A, Hall P, Nakamura S, et al: Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 1995; 91: 1676-1688 – reference: 12) Mousa I, Mario CD, Reimers B, et al: Subacute Stent Thrombosis in the Era of Intravascular Ultrasound-Guided Coronary Stenting Without Anticoagulation: Frequency, Predictors and Clinical Outcome. J AM Coll Cardiol 1997; 29: 6-12 – reference: 6) Fischerman DL, Leon MB, Baim DS, et al: A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Ned 1994; 331: 496-501 – reference: 26) Honda Y, Fitzgerald PJ: Stent thrombosis: an issue revisited in a changing world. Circulation 2003; 108: 2-5 – reference: 22) Matetzky S, Shenkman B, Guetta V, et al: Clopidogrel Resistance Is Associated With Increased Risk of Recurrent Atherothrombotic Events in Patients With Acute Myocardial Infarction. Circulation 2004; 109: 3171-3175 – reference: 2) Schuhlen H, Kastrati A, Pache J, et al: Incidence of thrombotic occlusion and major cardiac events between two and four weeks after coronary stent placement: analysis of 5678 patients with a four-week ticlopiridine regimen. J Am Coll Cardiol 2001; 37: 2066-2073 – reference: 16) Okabe T, Mintz GS, Buch AN, et al: Intravascular ultrasound parameters associated with stent thrombosis after drug-eluting stent deployment. Am J Cardiol 2007; 100: 615-620 – reference: 1) Cutlip DE, Baim DS, Ho K, et al: Stent thrombosis in the modern era a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103: 1967-1971 – reference: 15) Fujii K, Carlier SG, Mintz GS, et al: Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation. An intravascular study. J Am Coll Cardiol 2005; 45: 995-998 – reference: 27) Lemesle G, Delhaye C, Bonello L, et al: Stent thrombosis in 2008: definition, predictors, prognosis and treatment. Arch Cardiovasc Dis 2008; 101: 769-777 – reference: 24) Juhan-Vague I, Thompson SG, Jespersen J: Involvement of the hemostatic sysytem in the insulin resistnce syndrome: a study of 1500 patients with angina pectoris. Arterioscler Thromb 1993; 13: 1865-1873 – reference: 25) Chieffo A, Bonizzoni E, Orlic D, et al: Intraprocedual Stent Thrombosis During Implantation of Sirolimus-Eluting Stents. Circulation 2004; 109: 2732-2736 – reference: 20) Hulot JS, Bura A, Villard E, et al: CytochromeP450 2C19 loss-of-function polymorphism is a major determinent of clopidogrel responsiviness in healthy subjects. Blood 2006; 108: 2244-2247 – reference: 11) Iakovou I, Schmidt T, Bonizzoni E, et al: Incidence, predictor, and outcome of thromnosis after successful implantation of drug-eluting stents. JAMA 2005; 293: 2126-2130 – reference: 23) Reaven GM: Role of insulin resistance in human disease. Diabetes 1983; 37: 1595-1600 – reference: 10) Moses JW, Leon MB, Pompa JJ, et al: Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315-1323 – reference: 21) Desta Z, Zhao X, Shin JG, et al: Clinical significance of the cytochrome P450 2C19 genetic polymorphism. Clin Pharmacokinet 2002; 41: 913-958 – reference: 19) Fukuuchi Y, Tohgi H, Okudera T, et al: A randomized, double-blind study comparing the safety and efficacy of clopidogrel versus ticlopidine in Japanese patients with noncardioembolic cerebral infarction. Cerebrovasc Dis 2008; 25: 40-49 – reference: 7) Mehta RH, Harjai KJ, Cox DA, et al: Comparison of coronary stenting versus conventional balloon angioplasty on five year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2005; 96: 901-906 – reference: 3) George BS, Voorhees WD III, Roubin GS, et al: Multicenter investigation of coronary stenting to treat acute or threatened closure after percuaneous transluminal coronary angioplasty: Clinical and angiographic outcomes. J Am Coll Cardiol 1993; 22: 135-143 – reference: 14) Ponde CK, Aroney CN, McEniery PT, et al: Plaque prolapse between the struts of the intracoronary Palmaz-Schatz stent: report of two cases with a novel treatment of this unusual problem. Cathet Cardiovasc Diagn 2003; 40: 353-357 – reference: 4) Schatz RA: A view of intravascular stents. Circulation 1989; 79: 445-457 – reference: 13) Cheneau E, Leborgne L, Mintz GS, et al: Predictors of subacute stent thrombosis: results of a systemic intravascular ultra sound study. Circulation 2003; 1108: 43-47 – reference: 9) Mourice MC, Serrys PW, Sousa JE, et al: A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002; 346: 1773-1780 – reference: 5) Serruys PW, de Jaegere P, Kiemeneij F, et al: A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med 1994; 331: 489-495 |
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| Snippet | 症例は, 58歳, 男性. 2010年7月中旬に胸痛が持続するため, 当院紹介受診となる. 緊急冠動脈造影を施行したところ左前下行枝(#7)90％狭窄を認めたため, そのまま冠動... |
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| StartPage | 182 |
| SubjectTerms | slow flow ステント内プラーク逸脱 不安定狭心症 亜急性ステント血栓症 糖尿病 |
| Title | A case of an unstable angina pectoris which was repeated stent thrombosis 3 times and was needed bypass grafting finally |
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