: Multi-Link Penta stent mm PCI

Transcription

1 129 Vol. 34, pp , : CAG seg PCI 80 mmhg Multi-Link Penta stent mm CAG 5mm 50 9 CAG 75 PCI Cypher Driver stent mm Kissing balloon technique PCI ACS PCI CAG IVUS 1 2 : 60 71

2 130 : : 55 : : ; ; : I avl, V16 ST : t-pa 100 IU CAG LAD seg RCALCX LAD seg. 6 Fig. 1 PCI 80 mmhg Multi-Link Penta stent mm 25Fig. 2 PCI CK 5274 IUL, CK-MB 460 IUL 3 CAG LAD seg. 6 50Fig. 3 6 CAG LAD seg mm Fig. 4a4b 50 PCI 9 CAG Fig. 4c4d PCI LMT IVUS Fig. 5a LMT LAD seg mm Fig. 5b5c LMT Fig. 1. Emergency CAG at ACS. a RCA: no significant coronary stenosis b c LCA: 99 stenosis of LAD seg. 6 72

3 PCI 131 Fig. 2. Emergency PCI of LAD seg. 6. a Before PCI b During stent implantation c After PCI Fig. 3 Follow-up CAG 3 weeks after emergency PCI. a LCA: no early restenosis of LAD seg. 6 b c Left ventriculography Cypher stent LMT, LCX LAD 1 Driver stent mm LMT LAD Fig. 5d LMT 73

4 132 Fig. 4 Follow-up CAG 6 months and 9 months after emergency PCI. a b 6 months after: aneurysm and 50 stenosis of LAD seg. 6 c d 9 months after: aneurysm and 75 stenosis of LAD seg. 6 LAD, LCX 3.5 mm kissing balloon technique LAD seg 6 Fig. 5e5f PCI IVUS Fig. 6 PCI 7 CAG Fig. 7 CAG 1.5 CAG 4.9 Coronary Artery Surgery Study CASS 1 CAG PCI Bal 4 PCI CAG 3.9 Bell 5 directional coronary atherectomy DCA 10 Slota 6 PCI PCI PCI PCI 74

5 PCI 133 Fig. 5 Repeat PCI of LMT and LAD seg. 6 a Before repeat PCI b During balloon angioplasty c After balloon angioplasty d During kissing ballooning e After repeat PCI LMT PCI 48 75

6 134 Fig. 6 IVUS images. a Before repeat PCI b After repeat PCI Fig. 7 Follow-up CAG 7 months after repeat PCI. a b LCA: no restenosis of LMT and LAD seg. 6 8 veincoated stent PCI IVUS stent CAG 3.5 mm bare stent bare stent 1619 Beyer 16 bare stent IVUS IVUS 76

7 PCI IVUS CAG CAG, PCI CAG IVUS PCI bare stent bare stent ACS LAD PCI 6 bare stent Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, Mudd JG, Gosselin AJ. Aneurysmal coronary artery disease. Circulation 1983; 67: Tunick PA, Slater J, Kronzon I, Glassman E. Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients. J Am Coll Cardiol 1990; 15: Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis 1997; 40: Bal ET, Thijs Plokker HW, van den Berg EM, Ernst SM, Gijs Mast E, Gin RM, Ascoop CA. Predictability and prognosis of PTCA-induced coronary artery aneurysms. Cathet cardiovasc Diagn 1991; 22: Bell MR, Garratt KN, Bresnahan JF, Edwards WD, Holmes DR Jr. Relation of deep arterial resection coronary artery aneurysms after directional coronary atherectomy. J Am Coll Cardiol 1992; 20: Slota PA, Fischman DL, Savage MP, Rake R, Goldberg S. Frequency and outcome of development of coronary artery aneurysm after intracoronary stent placement and angioplasty. Am J Cardiol 1997; 79: Hill JA, Margolis JR, Feldman RL, Conti CR, Pepine CJ. Coronary arterial aneurysm formation after balloon angioplasty. Am J Cardiol 1983; 52: Dralle JG, Turner C, Hsu J, Replogle RL. Coronary artery aneurysms after angioplasty and atherectomy. Ann Thorac Surg 1995; 59: Wright WP, Alpert MA, Mukerji V, Santolin CJ. Coronary artery aneurysms: A case study and literature review. Angiology 1991; August: Gonzalez JM, Vallejo JL, Pineda T, Zuazo JA. Emergency surgery after coronary disruption complicating PTCA. Report of 4 cases. Thorac Cardiovasc Surg 1985; 33: Biglioli P, Alamanni F, Antona C, Agrifoglio M, Spirito R. Aneurysms of the coronary arteries: one case report. Thorac Cardiovasc Surg 1988; 36: Lentini S, Raymond G, Cartier P, Desaulniers D, Doyle D, Lemieux M, Metras J. Surgical treatment of left main coronary aneurysm. J Cardiovasc Surg 1994; 35: Gruberg L, Roguin A, Beyar R. Percutaneous closure of a coronary aneurysm with a vein- 77

8 136 coated stent. Cathet Cardiovasc Diagn 1998; 43: PTCA vein-covered stent ; 13: Autologous vein graft-coated stent PTCA ; 13: Beyer RW, Keen WD. Percutaneous stent treatment for a spontaneous coronary pseudoaneurysm. J Invasive Cardiol 1997; 9: Gruberg L, Grenadier E, Beyar R. Percutaneous closure of a coronary artery aneurysm with a bare stent. J Invasive Cardiol 1999; 11: PTCA ; 18: ; 18: Ge J, Liu F, Kearney P, Gorge G, Haude M, Baumgart D, Ashry M, Erbel R. Intravascular ultrasound approach to the diagnosis of coronary artery anrurysms. Am Heart J 1995; 130: Regar E, Klauss V, Henneke KH, Werner F, Theisen K, Mudra H. Coronary aneurysm after bailout stent implantation: Diagnosis of a false lumen with intravascular ultrasound. Cathet Cardiovasc Diagn 1997; 41:

9 PCI 137 Abstract Repair of a Left Anterior Descending Coronary Artery Aneurysm Late after Percutaneous Coronary Intervention by Implantation of Bare Stent: A Case Report Koichi Mizuno 1, Tomoo Harada 1, Toshio Sasaki 1, Osamu Tanaka 1, Satoru Nishio 1, Hisao Matsuda 1,andFumihiko Miyake 2 The patient was a 60 years old male who visited our hospital with chest pain as the major complaint. After administration of a thrombolytic agent under the diagnosis of acute coronary syndrome, emergency coronary angiography CAG was performed. Because of a 99 stenosis observed on the proximal site of the left anterior descending artery seg. 6 that also demonstrated substantial calcification, percutaneous transluminal coronary intervention PCI was subsequently conducted. Although the blood pressure dropped to 80 mmhg, Multi-link Penta stent mm was placed under intraaortic balloon pumping IABP with the reduction of stenosis to 25. As there was no early restenosis, the patient was discharged after 3 weeks. The coronary angiography CAG after 6 months indicated a 5 mm diameter coronary aneurysm on the proximal site of the stent. Because the stenosis inside the stent was about 50 and without chest symptom, the patient was followed up medically. An angina pectoris-like symptom occurred after 9 months, and subsequent CAG showed that the stenosis inside the stent increased to 75 or more despite no change in coronary aneurysm and ischemic change was detected in the electrocardiography under loaded condition. As a result, another revascularization was required. Although coronary artery bypass grafting could improve ischemia, there maybe still a risk of aneurysm rupture, PCI was performed. Although the use of drug eluting stent DES; Cypher was initially considered because of low stenosis rate, it was necessary to superpose the stent in some part because both the left main coronary trunk LMT and left circumflex artery LCX were thick, and there was substantial calcification of left anterior descending artery. Accordingly, a thin strut Driver stent mm was retained and Kissing balloon technique was performed from LMT to left anterior descending artery and LCX. As a result, the left anterior descending artery was su$ciently dilated and the coronary aneurysm mostly disappeared. The clinical course was favorable without subsequent cardiovascular event. 1 Department of Cardiology, Kawasaki Municipal Tama Hospital, Appointed Administrator, St. Marianna University School of Medicine 2 Department of Cardiology, St. Marianna University School of Medicine 79