Denegri Andrea, Ameri Pietro, Paparo Francesco, Murialdo Giovanni
aCardiocentro Ticino, via Tesserete 48, Lugano, Ticino, Switzerland bDepartment of Internal Medicine and Medical Specialities, Center of Excellence for Biomedical Research, San Martino-IST University Hospital - IRCCS, University of Genoa, viale Benedetto XV 6, Genoa cS.C. Radiodiagnostica, E.O. Ospedali Gallieria, via delle Cappuccine 14, Genoa.
J Cardiovasc Med (Hagerstown). 2016 Dec;17 Suppl 2:e176-e177. doi: 10.2459/JCM.0000000000000083.
: Cocaine is the most commonly used recreational drug among young adults with levels reaching epidemics proportions. This accelerated rate of use is due mainly to easy access and administration, reduced cost, and, importantly, underestimation of the drug risks. Cocaine, instead, is responsible of endothelial dysfunction and accelerated atherosclerosis with consequent organ damage. Cocaine abuse is not only associated with central necrotizing vasculitis, but it is also appeared to play a role in the development of peripheral vasoconstriction with symptoms similar to Buerger's disease. The current study reports a middle-aged man addicted to cocaine for 20 years. The patient presents several cardiovascular disease risk factors and manifestations, including diabetes mellitus and hypertension. Additionally, arteriography showed complete left posterior tibial artery obstruction with distal collateral vessels and severe leftfoot ischemia. For clinical worsening 1 month later, the patient underwent another arteriography. Although angioplasty of posterior tibial artery showed recovery of blood flow, immediately after treatment (selective percutaneous transluminal angioplasty of posterior tibial artery, dilation with balloon without stenting), a return to pretreatment blood flow 2 min later was observed. This transient change was mediated by severe vasospasm resulting in a complete re-obstruction of the vessel. The poor vascular manifestations are most probably due to cocaine-necrotizing vasculitis subsequent to endothelial dysfunction and accelerated atherosclerosis usually associated with cardiovascular risk factors. Therefore, treatments of young cocaine addicts presenting many cardiovascular risk factors and manifestations should always be carefully investigated and cautiously approached, especially in those with poor outcomes.
可卡因是年轻成年人中最常用的消遣性毒品，其使用量已达到流行程度。这种使用量的加速增长主要归因于其易于获取和使用、成本降低，以及重要的是，对毒品风险的低估。相反，可卡因会导致内皮功能障碍和动脉粥样硬化加速，进而造成器官损害。可卡因滥用不仅与中枢性坏死性血管炎有关，而且似乎在周围血管收缩的发展中起作用，其症状类似于血栓闭塞性脉管炎。本研究报告了一名有20年可卡因成瘾史的中年男性。该患者存在多种心血管疾病风险因素和表现，包括糖尿病和高血压。此外，血管造影显示左胫后动脉完全阻塞，伴有远端侧支血管，以及严重的左足缺血。1个月后，由于临床症状恶化，患者接受了另一次血管造影。尽管胫后动脉血管成形术显示血流恢复，但在治疗后立即（选择性胫后动脉经皮腔内血管成形术，使用球囊扩张但未置入支架），2分钟后观察到血流恢复到治疗前水平。这种短暂变化是由严重的血管痉挛介导的，导致血管完全再次阻塞。血管表现不佳很可能是由于内皮功能障碍和通常与心血管风险因素相关的动脉粥样硬化加速后出现的可卡因坏死性血管炎。因此，对于有多种心血管风险因素和表现的年轻可卡因成瘾者的治疗，应始终进行仔细研究并谨慎处理，尤其是在那些预后不良的患者中。
