Fujita Akira, Kurazumi Hiroshi, Suzuki Ryo, Takahashi Masaya, Mikamo Akihito, Hamano Kimikazu
Department of Surgery and Clinical Science, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
Surg Case Rep. 2018 Jul 27;4(1):82. doi: 10.1186/s40792-018-0481-9.
Coronary vasospasm after coronary artery bypass grafting (CABG) is a rare but potentially lethal complication. It is often refractory to several vasodilators. We report a case of refractory coronary vasospasm relieved by fasudil injection.
A 74-year-old woman who had three instances of in-stent stenosis at the left anterior descending artery (LAD) was referred for CABG treatment. Preoperative coronary angiography showed 90% in-stent stenosis of the proximal LAD and 75% stenosis of the diagonal branch. We performed a left internal thoracic artery (LITA)-LAD bypass and a right internal thoracic artery (RITA) diagonal branch bypass. After anastomosis, transit time flow measurement revealed poor blood flow of LITA-LAD bypass even after re-anastomosis. We performed coronary angiography and detected a vasospasm in the native coronary arteries, which was not relieved using conventional vasodilators (calcium channel blockers, isosorbide dinitrate, and nicorandil) However, we were able to relieve the coronary vasospasm by administering fasudil (a Rho kinase inhibitor) injection without causing systemic hypotension.
Fasudil may be an important vasodilator, especially in cases of coronary vasospasm after CABG.
冠状动脉旁路移植术（CABG）后发生冠状动脉痉挛是一种罕见但可能致命的并发症。它通常对多种血管扩张剂无效。我们报告一例经法舒地尔注射缓解的难治性冠状动脉痉挛病例。
一名74岁女性，左前降支（LAD）有3次支架内狭窄，因CABG治疗前来就诊。术前冠状动脉造影显示LAD近端支架内狭窄90%，对角支狭窄75%。我们进行了左乳内动脉（LITA）-LAD搭桥和右乳内动脉（RITA）对角支搭桥。吻合后，经时血流测量显示即使再次吻合后LITA-LAD搭桥的血流仍很差。我们进行了冠状动脉造影，发现自身冠状动脉存在血管痉挛，使用传统血管扩张剂（钙通道阻滞剂、硝酸异山梨酯和尼可地尔）无法缓解。然而，我们通过注射法舒地尔（一种Rho激酶抑制剂）缓解了冠状动脉痉挛，且未引起全身性低血压。
法舒地尔可能是一种重要的血管扩张剂，尤其是在CABG后发生冠状动脉痉挛的情况下。
