Kaku Bunji, Ikeda Masahiro, Kato Hiroki, Takabatake Shu, Hayashi Tatsumi, Taguchi Tomio, Niita Yutaka, Hiraiwa Yoshio, Aoki Shuichi
Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Toyama.
Int Heart J. 2007 May;48(3):379-85. doi: 10.1536/ihj.48.379.
A 74-year-old man had undergone on-pump coronary artery bypass grafting (CABG) for effort-induced angina pectoris. Soon after CABG using the left internal thoracic artery for the left anterior descending artery and saphenous vein for the left circumflex artery, ST elevation was found in the inferior leads and complete atrioventricular block, ventricular tachycardia, and circulatory collapse occurred. Emergent coronary angiography revealed diffuse severe spasm of the right coronary artery (RCA). Despite the intravenous and intracoronary administration of massive doses of vasodilators and intra-aortic balloon pumping, the coronary spasm did not resolve. Five stents were deployed from the distal to the proximal portion of the RCA. After multistenting, coronary flow was dramatically improved and the ST elevations in the inferior leads were also improved. Coronary artery spasm after CABG is relatively rare, but when it occurs, it can be fatal. Multistenting is a useful treatment for life-threatening refractory coronary spasm after CABG.
一名74岁男性因劳力性心绞痛接受了体外循环冠状动脉旁路移植术（CABG）。在使用左乳内动脉连接左前降支、大隐静脉连接左旋支进行CABG后不久，下壁导联出现ST段抬高，并发生了完全性房室传导阻滞、室性心动过速和循环衰竭。急诊冠状动脉造影显示右冠状动脉（RCA）弥漫性严重痉挛。尽管静脉内和冠状动脉内给予了大剂量血管扩张剂并进行了主动脉内球囊反搏，但冠状动脉痉挛仍未缓解。从RCA远端至近端植入了5枚支架。多支架植入后，冠状动脉血流显著改善，下壁导联的ST段抬高也有所改善。CABG术后冠状动脉痉挛相对少见，但一旦发生可能致命。多支架植入是治疗CABG术后危及生命的难治性冠状动脉痉挛的有效方法。
