Primary stenting 後に2度の亜急性血栓性閉塞を発症したと考えられる急性心筋梗塞の1例

Abstract

A 61-year-old man was admitted to our hospital with an acute myocardial infarction. Emergency coronary angiography revealed complete occlusion in seg. 6 of left anterior descending artery (LAD). Primary PTCA was performed; however, dissection occurred at the site of balloon inflation. Although two Gianturco-Rubin Ⅱ stents were implanted at the sites of dissection, dissection did not disappear. On the 9th hospital day, subacute thrombosis (SAT) occurred in seg. 6. Occluded LAD was revasculized by PTCA, but dissection was present at seg. 6 and seg. 7. Palmaz-Shatz stent was implanted to seg. 6, but dissection in seg. 7 did not disappear. On the 14th hospital day, recurrence of SAT was clinically suspected, and alteplase was administered intravenously. Coronary angiogra- phy performed on the 61st day revealed no significant stenosis in the LAD, but indicated aneurysm formation in seg. 6. Remaining dissection after stent implantation may have provoked two occurrences of SAT in this case.