冠状動脈穿孔に対して冠状動脈バイパス術とコイル塞栓を施行した1例

Coronary Artery Perforation Treated with Coronary Artery Bypass Grafting and Coil Embolization：Report of a Case

はじめに　近年，冠状動脈疾患に対しては経皮的冠状動脈形成術（PCI）が主流となり，それに伴い合併症も増加している．デバイスの進歩によりリカバリーできる症例もあるが十分とはいえず，外科的処置を要することも多い．われわれはPCI後の出血に対しカバードステントで止血困難であった症例に対して，冠状動脈バイパス術（CABG）および冠状動脈コイル塞栓で救命しえた症例を経験したので，文献的考察を加え報告する．

In recent years, percutaneous coronary intervention （PCI） has become mainstream for the treatment of coronary artery disease, and complications associated with this procedure are increasing accordingly. Coronary perforation, a complication of PCI, is rare but may lead to cardiac tamponade. Once cardiac tamponade occurs, the mortality rate increases. An 88-year-old man underwent coronary angiography that showed perfect right coronary occlusion. Coronary perforation occurred after the deployment of a drug-eluting stent （DES）. We could not stop the bleeding despite covered stent implantation. We performed hybrid surgery, coronary artery bypass grafting （CABG） and coil embolization. The patient progressed uneventfully and was discharged on postoperative day 59. The combination of coil embolization and CABG may be an alternative strategy for treating coronary perforation.