ステロイド治療が著効した心臓カテーテル後コレステロール塞栓症の1例

A Report of Successful Treatment by Steroid of Cholesterol Embolism Occurring after Coronary Angiography

患者は65歳男性．既往歴は高血圧，高脂血症，狭心症．狭心症で心臓カテーテル検査施行．左前下行枝の狭窄と腎動脈分岐部末梢に最大径50mmの腹部大動脈瘤を認めた．左前下行枝に経皮的冠動脈形成術を施行し退院したが，歩行時下肢痛，腎機能障害，高血圧が悪化，緊急高血圧症のため再入院．大腿に網状皮斑，血液検査で腎機能障害(クレアチニン3.8mg/dl)，眼底にコレステロール結晶を認め，コレステロール塞栓症と診断．抗血小板薬の中止，スタチン，プロスタグランジン製剤の点滴，降圧剤の投与などを行ったが悪化．発症4週間後よりステロイド治療を開始したところ，症状および腎機能の改善を認めた．その後ステロイドを漸減，疼痛は消失しクレアチニン3.0mg/dlで退院．以上の経過より，コレステロール塞栓症にステロイド治療が有効である可能性が考えられた．

A 65-year-old man who had lost consciousness twice was admitted to coronary angiography because of ischemia of his left anterior artery ditected by cardiac scintigraphy. Coronary angiography revealed stenosis of the patient's left anterior descending artery and aneurysm just below the bifurcation of the renal artery. Percutaneous coronary intervention was performed successfully and he was discharged. However, he was admitted again due to pain in his legs while walking, renal dysfunction, and emergency hypertension. From his symptoms including blood-test and cholesterol crystals in his eye-grounds, we diagnosed the patient as having cholesterol embolism. His condition worsened in spite of treatment, so we started to use steroid. Following steroid treatment, he recovered and was discharged. We conclude that steroid might be effective for treating cholesterol embolism.