Hiroki Junko, Fukumoto Yoshihiro, Shimokawa Hiroaki, Hirooka Yoshitaka, Takeshita Akira
Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka.
J Cardiol. 2004 Oct;44(4):161-4.
An 86-year-old woman was admitted with unstable angina pectoris. Plain old balloon angioplasty (POBA) was performed for 90% stenosis at segment 7 of the left coronary artery with concomitant treatment with nitrate, calcium antagonists, and nicorandil. Five days after POBA, she again suffered chest pain at rest with ST depression by electrocardiography, despite increased doses of calcium-antagonist and nicorandil. Coronary arteriography showed no evidence of restenosis (50%) at the POBA site. The involvement of coronary artery spasm was considered and intravenous treatment with a Rho-kinase inhibitor, fasudil, was started, which resulted in disappearance of the anginal attacks. She refused to continue the fasudil treatment on day 5, which resulted in reappearance of anginal attacks. Third coronary angiography showed a 90% restenosis at POBA site and percutaneous coronary intervention was again performed. This case suggests that a Rho-kinase inhibitor is potentially effective to prevent anginal attacks in spastic angina.
一名86岁女性因不稳定型心绞痛入院。对左冠状动脉第7节段90%狭窄处进行了单纯球囊血管成形术（POBA），同时使用硝酸盐、钙拮抗剂和尼可地尔进行治疗。POBA术后5天，尽管增加了钙拮抗剂和尼可地尔的剂量，但她仍再次出现静息性胸痛，心电图显示ST段压低。冠状动脉造影显示POBA部位无再狭窄（50%）迹象。考虑冠状动脉痉挛的可能性，开始静脉注射Rho激酶抑制剂法舒地尔进行治疗，结果心绞痛发作消失。第5天她拒绝继续使用法舒地尔治疗，随后心绞痛发作再次出现。第三次冠状动脉造影显示POBA部位出现90%再狭窄，再次进行了经皮冠状动脉介入治疗。该病例表明，Rho激酶抑制剂可能对预防痉挛性心绞痛的心绞痛发作有效。
