ACバイパス術後，グラフト狭窄に対しPTCAを反復施行した1例

A case of repeat percutaneous transluminal coronary angioplasty for recurrent aorto-coronary bypass graft stenosis

　近年，虚血性心疾患の治療法として経皮的冠動脈形成術（PTCA）が広く行われるようになった^1,2）。またそのSystemの改良や技術の向上により成功率が高まるにつれ適応は拡大されている。最近では多枝病変^3），不安定狭心症^4），vasospastic angina^5）や急性心筋梗塞^6）に対してもPTCAは行われるようになった。一方，大動脈—冠動脈バイパス術（ACバイパス術）後のグラフト狭窄に対しては従来再手術が施行されていたが，最近ではPTCAも試みられるようになり安全かつ有効な治療手段として評価されてきている^7〜11）。今回著者らは，自家大伏在静脈片（SVG）によるACバイパス術後のグラフト狭窄に対しPTCAを反復施行した1例を経験したので報告する。

A case treated with repeat percutaneous translu-minal coronary angioplasty (PTCA) for recurrent aorto-coronary bypass graft stenosis was reported.

A 52-year-old woman with effort angina pectoris underwent aorto-coronary bypass with a sequential saphenous vein graft to the left anterior descending artery and second diagonal.

Recurrent angina occurred 4 months after operation and coronary arteriography revealed multiple steno-tic lesions in the bypass graft. PTCA was performed and stenose were successfully dilated.

3 months after the first PTCA, a long segment stenosis was found in the bypass graft. Repeat PTCA successfully dilated the lesion. However 2 months after the second PTCA, the bypass graft was com-pletely occuluded at the site of aortic anastomosis.

In this case, the bypass graft was finally occuluded in spite of repeat PTCA. But recurrent angina and ST depression in an exercise ECG due to graft stenosis were markedly improved by PTCA for the graft being safely performed.

PTCA for aorto-coronary bypass graft stenosis is considered to be a safe and effective therapeutic procedure.