Grollier G, Scanu P, Commeau P, Foucault J P, Potier J C
Clin Cardiol. 1985 Dec;8(12):644-8. doi: 10.1002/clc.4960081207.
We report the observation of a 62-year-old patient who was admitted for unstable angina. A prolonged chest pain (more than two hours) with a major electrocardiographic lesion in the posterior leads needed an urgent coronary arteriography in order to attempt a recanalization. Antecedents of arteriopathy of the lower limbs with aortobifemoral bypass required an axillary artery right side approach. A selective right coronary opacification showed complete occlusion at the junction of segments 1 and 2. An intracoronary injection of isosorbide dinitrate relieved a coronary spasm and allowed a complete visualization of the right coronary artery. This appeared to be very atherosclerotic with several severe narrowings, and a subocclusive lesion at the site of the initial occlusion. Percutaneous transluminal coronary angioplasties (PTCA) were performed and led to real 'restructuring' of the right coronary artery. The clinical outcome was excellent without recurrent angina pectoris. An angiographic control performed 6 months after PTCA demonstrated the persistence of the coronary recanalization and an evident improvement of the segmental contractility. This report emphasizes the role of coronary spasm in the genesis of myocardial infarction and shows that PTCA may be performed as a first approach at the acute phase of myocardial infarction; to our knowledge it is the first PTCA performed by an axillary approach at the acute stage of myocardial infarction.
我们报告了一名62岁因不稳定型心绞痛入院患者的观察情况。患者出现长时间胸痛（超过两小时），后侧壁导联有明显心电图改变，需要紧急进行冠状动脉造影以尝试再通。患者有下肢动脉病变并接受了主动脉双股动脉搭桥手术史，因此采用右侧腋动脉入路。选择性右冠状动脉造影显示第1和第2节段交界处完全闭塞。冠状动脉内注射硝酸异山梨酯缓解了冠状动脉痉挛，使右冠状动脉得以完全显影。该动脉显示出严重的动脉粥样硬化，有多处严重狭窄，初始闭塞部位有次全闭塞病变。进行了经皮腔内冠状动脉成形术（PTCA），实现了右冠状动脉的真正“重塑”。临床结果良好，未再发心绞痛。PTCA术后6个月的血管造影复查显示冠状动脉再通持续存在，节段性收缩力明显改善。本报告强调了冠状动脉痉挛在心肌梗死发病中的作用，并表明PTCA可作为心肌梗死急性期的首选治疗方法；据我们所知，这是首次在心肌梗死急性期通过腋动脉入路进行的PTCA。
