DispatchTM使用によるアルガトロバン局所投与が有効であった急性心筋梗塞の1例

Use of the Local Intracoronary Argatroban Using DispatchTM in Acute Myocardial Infarction

　症例は79歳の女性で，急性心筋梗塞（以下AMI）の診断で緊急冠動脈造影を行った．右冠動脈（以下RCA）seg3で完全閉塞を認め，経皮的冠動脈形成術（以下PTCA）を施行した．施行中血栓像と思われる不整な陰影欠損，末梢塞栓を認めたためにtissue plasminogen　activator（以下t-PA）を投与したが，逆に血栓性閉塞を来したために，新たな血栓形成を抑制させる目的でDispatch^TM　catheterを用いて，凝固活性賦活作用の弱い選択的トロンビン阻害剤であるアルガトロバンを冠動脈内に局所投与し，血行再建に成功した．

A 79-year-old woman was admitted 4 hours after the onset of acute inferior myocardial infarction secondary to total occlusion of seg. 3 of the right coronary artery. It was recanalised with direct coronary angioplasty. but with evidence of residual thrombus and distal embolism, for which intracoronary nasaruplase (6000 units) was perfused using a conventional angioplasty baloon cath-eter. Massive thrombus and total occlusion of seg. 2 of the right coronary artery appeared. Because of unre-sponsiveness to nasaruplase, local intracoronary ar-gatroban (5 mg) over a period of 20 minutes was per-fused using DispatchTM catheter. It resulted in reduction of the residual stenosis of the lesion he 50%.