PTCAに伴う冠動脈瘤が慢性期に著明に縮小した1例

A Case of Coronary Aneurysm following PTCA Which was Markedly Reduced in the Chronic Phase

　症例は56歳，女性．1995年9月に急性心筋梗塞の既往があり，慢性期冠動脈造影で左回旋枝＃11の完全閉塞を認めた．1996年7月に胸痛発作があり，精査加療の目的で当科紹介された．入院時心電図は虚血性ST-T変化を認め，負荷心筋シンチでは後側壁の固定性欠損と下壁の再分布所見を認めた．冠動脈造影では左回旋枝＃11の完全閉塞に加えて右冠動脈＃3に90％狭窄を認め，＃3に対してPTCAを施行し冠解離の形成もなく33％に拡張された．3カ月後の確認造影では＃3は65％狭窄で8×3mm大の冠動脈瘤の形成を認めた．さらに3カ月後の造影では冠動脈瘤は造影上著明に縮小していたが，＃3は75％狭窄に進行していた．後日GR IIステント植え込みを行い良好に拡張でき，再狭窄も認めなかった．以上，PTCA後の冠動脈瘤の自然経過を観察し得た症例について報告した．

A 56-year-old woman with a history of myocardial infarction was admitted to our hospital because of chest pain. Electrocardiogram showed ischemic ST - Tchanges, and stress T1 myocardial scintigraphy showed persistent defect in the posterolateral wall and redistri-bution in the inferior wall. The coronary angiogram revealed total obstruction at # 11 of the left circumflex artery and 90%stenosis at # 3 of the right coronary artery (RCA). PTCA for RCA # 3 was undertaken and the stenosis was dilated without coronary dissection. Three months later, the coronary angiogram showed aneurysm formation with a size of 8×3 mm and with 65 % stenosis at the same portion. Six months later, the coronary aneurysm was markedly reduced, but reste-nosis had progressed to 75%. Therefore. we performed GE II stent implantation for RCA # 3 and the lesion was dilated adequately and 3 months later, restenosis had disappeared. Thus, we had encountered a rare case in whichl we could observe the natural course of a coro-nary aneurysm following PTCA.