DCAにより冠動脈左主幹部狭窄を来した1手術治験例

A Case Report of Surgical Aorto Coronary Bypass Grafting for Left Main Artery Stenosis following Directional Coronary Atherectomy

　今回われわれは，二度の方向性冠動脈粥腫切除術（directional coronary atherectomy：DCA）施行後に冠動脈左主幹部（LMT）狭窄を来した症例を経験し手術を施行したので報告する．症例は59歳，男性で，右冠動脈領域（Seg．3）の急性心筋梗塞にて入院し，経皮的冠動脈血栓溶解術，血管形成術を施行した後，合併した左冠動脈狭窄（Seg．6：90％）に対しDCAを施行した．89日後に再狭窄（25→90％）を来したため再度DCAを施行した．2カ月後LMTに狭窄（90％）を認め，準緊急冠動脈バイパス術を施行した．DCAに用いられるガイディングカテーテルは10Fr．と太く，カテーテルの出し入れの操作回数も多く，より一層慎重なカテーテル操作と，厳密な経過観察が必要と思われる．

We encountered a 59-year-old male patient suffering from left main coronary artery (LMT) stenosis follow-ing directional coronary atherectomy (DCA). He was admitted to our hospital because of acute myocardial infarction. After successful treatment with per-cutaneous transluminal coronary recanalization and angioplasty for the right coronary artery, DCA was carried out for the left anterior descending artery (LAD). 89 days later, he received DCA for re-stenosis of LAD. About 2 months after the second DCA, he complained of chest pain caused by LMT stenosis. Intima injury caused by the guiding catheter during the DCA procedure seems to be the main reason for LMT stenosis following DCA. More delicate catheter han-dling and careful follow up are necessary to avoid an accident caused by DCA such as happened in our case.