大動脈弁置換術周術期に超遅発性ステント血栓症を合併した1例

Very Late Stent Thrombosis during Perioperative Period of Aortic Valve Replacement：Report of a Case

はじめに　経皮的冠状動脈形成術（PCI）は，薬剤溶出性ステント（drug eluting stent：DES）の出現により，ステント内再狭窄の問題が解決されつつある．しかし，遅発性のステント内血栓症が認められるようになった．われわれは，大動脈弁置換術（AVR）周術期にDESを使用したPCI後の超遅発性ステント血栓症（very late stent thrombosis：VLST）を認めた1例を経験したので報告する．

A 73-year-old man underwent drug eluting stent （DES） implantation in the left anterior descending artery （LAD） 11 years ago and in the right coronary artery （RCA） 8 years ago. He suffered from chest tightness and was diagnosed with severe aortic valve stenosis. Perioperative coronary angiography revealed no significant stenosis and thrombotic occlusion of the DES. Five days before operation, antiplatelet therapy was discontinued. Aortic valve replacement was performed uneventfully. But he developed chest pain and transient loss of consciousness, electrocardiographic changes were observed on the 8th postoperative day. Emergency coronary angiography revealed thrombotic occlusion of the drug eluting stent in the RCA, despite the postoperative oral adoministration of warfarin and aspirin. Percutaneous catheter intervention （PCI） restored the stent patency. Dual antiplatelet therapy （DAPT） was initiated immediately after the PCI, and anticoagulation therapy with warfarin was continued. Clinical symptons of stent thrombosis disappeared immediately after the PCI. He was discharged 7 days after the PCI.