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64歳男性,非Q波心筋梗塞にて入院した.左冠動脈前下行枝(No.6)に90%狭窄を認めた.経皮的冠動脈形成術にて狭窄は改善したが,拡張時にバルーンが近位側にスリップし,逆行性に冠動脈解離を来した.急性冠閉塞はなく,運動能も改善したため経過観察としたが,3ヵ月後に突然胸痛を訴え,直後に死亡した.剖検では,左冠動脈近位部において内膜と中膜の断裂と解離,著明な細胞反応による高度な狭窄を認め,急性心筋虚血が死因と考えられた.冠動脈解離は急性冠閉塞だけでなく,内膜損傷による高度な細胞反応を誘発し,急速な再狭窄を来しうることが示唆された.
A case report of the sudden death of a 64-year-old man, three months after successful percutaneous trans-luminal coronary angioplasty (PTCA). He was admit-ted because of non-Q-wave acute myocardial infarc-tion. Coronary angiography showed 90% stenosis in the anterior descending artery (No. 6). PTCA was success-ful, but the proximal portion of anterior descending artery was dissected because the balloon slipped from the dilated site during inflation. Acute coronary occlu-sion was not observed. However, he died suddenly shortly after he complained of severe chest pain three months after PTCA.
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