経皮的冠状動脈形成術後の仮性冠状動脈瘤に対し二期的ハイブリッド治療を行った1例

Staged Hybrid Treatment for a Coronary Artery Pseudoaneurysm after Percutaneous Coronary Intervention；Report of a Case

はじめに　冠状動脈瘤は経皮的冠状動脈形成術（PCI）の合併症としては比較的少ないが，PCI施行件数の増加に伴って遭遇する機会が増えている．右冠状動脈（RCA）近位部におけるPCI後の仮性冠状動脈瘤に対し，冠状動脈バイパス術（CABG）後にカバードステント留置で瘤閉鎖する二期的治療を行った症例を経験したので，報告する．

We herein report a case of a coronary artery pseudoaneurysm caused by previous catheter intervention, who was treated with a staged hybrid procedure of coronary artery bypass grafting （CABG） and subsequent percutaneous catheter intervention. A 59-year-old man underwent an urgent percutaneous coronary stent placement for acute myocardial infarction at segment 1 of the right coronary artery, where later coronary pseudoaneurysm developed. Prior to closure of the aneurysm by covered stent placement, he underwent CABG to segment 3 using the right internal thoracic artery graft, in case the implanted covered stent should acutely thrombose in the future. The graft flow was increased by producing an artificial stenosis just proximal to the anastomosis. The present technique would be a safe and viable option of therapeutic strategy to fix coronary artery pseudoaneurysms that have been formed at the proximal segment of main coronary arteries.