左内胸動脈—前下行枝吻合部狭窄に対してPTCAを施行し，グラフト体部で急性閉塞を来した1例

A Case Report of Acute Mid-graft Occlusion of the Left Internal Mammary Artery to the Left Anterior Descending Artery after PTCA

　症例は66歳，女性で，心筋梗塞後狭心症のため左内胸動脈-前下行枝にバイパス術を施行された．術後の確認造影検査で90％の吻合部狭窄を認め，同部位にPTCAを施行した．1.5mm,2.0mmで拡張直後，グラフト体部に完全閉塞を来した．スパスムを疑い，硝酸イソソルビドのグラフト内注入を行ったが，閉塞は消失せず，準緊急に再手術（大伏在静脈-左前下行枝）を施行した後，症状は消失した．以上，グラフト吻合部狭窄に対するPTCA時にも急性閉塞などの合併症に留意すべきである．

A 66 year-old woman underwent coronary artery bypass grafting for postinfarction angina. A left inter-nal mammary artery graft was joined to the left ante-rior descending artery. Coronary and graft angiography revealed a 90% stenosis in the anastomotic site of the left internal mammary artery. During PTCA with a 2.0 mm balloon catheter, acute occlusion of the graft body occurred. Intragraft injection of isosorbide dinitrate failed to dilate the graft. Thus, careful consideration should be given to several complications such as acute occlusion of the graft when PTCA for anastomotic site of the graft is performed.