急性心筋梗塞を合併した単冠動脈症に対しステント植込みを施行した1例

A Case of Primary Coronary Angioplasty and Stenting in a Patient with an Isolated Single Coronary Artery and Acute Myocardial Infarction

　患者は，心筋梗塞を発症したLipton L II-A型の単冠動脈症の71歳，女性．左前下行枝より右冠動脈に相当する枝が分岐する直前に，AHA分類で90％の狭窄部位を認め，責任病変と考えた．この部位は左冠動脈主幹部と同様の扱いをするべき部位であるが，本症例ではrisk areaが広範囲であり，速やかな血流確保が不可欠と考え，PTCAおよびステント植込みを行い良好な血流を得た．単冠動脈症に対するPTCAの報告は現在までに17例，ステント植込みの報告は5例あるが，今回のような左冠動脈主幹部に相当する広範なrisk areaに対するPTCAの報告は1例のみであった．現在，患者は経過順調で，外来で慎重に経過観察されている．

We encountered a case of a 71-year-old female with acute myocardial infarction associated with a Lipton L II -A type single coronary artery. There was 90% stenosis in the coronary artery equivalent to the left anterior descending artery immediatery before the bifur-cation equivalent to the right coronary artery. Since the area at risk of ischemia was extensive, prompt reper-fusion was necessary, so we performed primary per-cutaneous transluminal coronary angioplasty (PTCA) and stenting successfully. Seventeen cases of PTCA reported and five cases of stenting in patients with a single coronary artery have been reported. However, there has been only one previous report of PTCA for a lesion with an extensive risk area equivalent to that of the left main trunk, as was the case in our patient. Her clinical course has been satisfactory and free from angina attacks, and patient remains under follow-up as an outpatient.