RescueTMシステムによる血栓吸引直後より冠血流速がno reflow patternを示した急性心筋梗塞の1例

No Reflow' Coronary Flow Velocity Pattern After Thrombectomy Using the RescueTM System in a Patient With Acute Myocardial Infarction

　患者は広範前壁心筋梗塞を発症した73歳，男性．緊急冠動脈造影にて左前下行枝近位部で完全閉塞を認めた．Rescue^TMシステムにて血栓の吸引を行い十分な最小血管径が得られたが，再灌流直後よりTIMI 2の造影遅延を認めた．ドプラガイドワイヤーによる冠血流速の測定では，no reflow現象に特徴的な所見である収縮早期逆流波の出現，および拡張期血流速の急激な減速を認めた．引き続き経皮的冠動脈形成術およびステント植込みを施行し，責任病変は良好な拡張が得られたが，造影遅延は残存した．本症例はno reflow現象が冠動脈病変部からの微小塞栓子が存在しなくても生じ得ることを示唆していると考えられた．

We described here a case of a 72- year-old male with acute anterior myocardial infarction who underwent thrombectomy using the Rescue' system and stent implantation. On emergent angiography, total occlusion of the proximal left anterior descending artery was observed. There was a large amount of thrombus at the culprit lesion, so we performed thrombectomy using Rescue^TM, which resulted in Thrombolysis in Myocardial Infarction (TIMI) 2 flow despite sufficient minimal lumen diameter. Coronary blood flow velocity at the distal left anterior descending artery with a Doppler guide wire showed the `no reflow' pattern, which was characterized by early systolic retrograde flow, reduced systolic forward flow and a rapid deceleration of dia-stolic flow velocity. We performed additional balloon angioplasty and stent implantation, but TIMI 2 flow remained in spite of our angiographically reopening the culprit lesion. This case suggested that the 'no reflow' phenomenon can occur without microemboli from a culprit lesion of the coronary artery.