RescueTMカテーテルで多量の血栓，粥状物が吸引された急性心筋梗塞の1例

A Case Report of Acute Myocardial Infarction with Aspiration of a Massive Thrombus and an Atheroma by using a RescueTM Catheter

　われわれは，Rescue^TMカテーテルで多量の血栓，粥状物が吸引された急性心筋梗塞の1例を経験した．患者は84歳，男性．発症4時間の急性下壁梗塞でII,III,aVF,V₅〜V₆でSTの上昇，完全房室ブロックを認めたため緊急冠動脈造影を施行した．右冠動脈seg1で完全閉塞のためインターベンションを開始した．Rescue^TMカテーテルが病変部を通過しないため，バルーンで前拡張後病変部を通過させ吸引を開始した．カテーテルの先端に血栓が吸着し，すぐに吸引できなくなるため，カテーテルを抜いて吸引ルーメンのフラッシュを頻回に行った．合計10回の吸引後TIMI IIIの血流が得られたが，著明なアコーディオン現象を認めたため，ステントを3個挿入した．留置後，末梢塞栓，再灌流不全現象（no-reflow　phenomenon）を起こすことなく良好な血流が得られ終了した．吸引物は新鮮血栓，多量の粥状物であった．

An 84-year-old man with acute myocardial infarctionwas admitted 4 hours after onset of chest pain. His rightcoronary artery was completely obstructed at the prox-imal portion.After predilatation by conventional bal-1oon catheter with low pressure, a Rescue^TM catheterwas crossed at the distal end of the lesion. Aspirationwas performed ten times and a massive thrombus and anatheroma were removed. After thrombectomy, coronaryaccordion phenomenon and intimal darnage in the lesionwere revealed. Subsequently, adjunctive balloon angio-plasty and deployment of 3 stents were pefformed.Neither distal embolization nor the absence of reflowphenomenon was observed after the procedure. Rescue^TMcatheter is considered to be useful for revascularizationtherapy in patients with acute inferior myocardialinfarction.