Hashida Hidetoshi, Funada Jun-Ichi, Morioka Norikatsu, Iwata Takeru
Department of Cardiovascular Medicine, National Hospital Organization Ehime National Hospital, 366 Yokogawara, Toon, Ehime Prefecture 791-0203, Japan.
J Cardiol Cases. 2009 Nov 8;1(1):e1-e5. doi: 10.1016/j.jccase.2009.05.002. eCollection 2010 Feb.
We describe the case of a 59-year-old male. His first percutaneous coronary intervention (PCI) using a bare metal stent was performed for a 90% stenosis in the mid portion of the left anterior descending artery (LAD). However, we performed re-PCI because in-stent restenosis developed during a chronic stage. After the first dilatation of the restenotic lesion, using a cutting balloon, the stenosis at the ostium of the septal branch, which takes off from the stent strut, became exacerbated. Therefore, after selective guidewire insertion to the septal branch, we performed balloon inflation. Unfortunately, a coronary dissection and perforation developed in the septal branch and a coronary arteriovenous shunt was also formed. Additional inflation for in-stent restenosis with a perfusion balloon provided successful occlusion of the ostium of the septal branch and the shunt flow disappeared. After careful re-selection of a guide wire into the septal branch, the perforated portion was then dilated using a small-sized conventional balloon. Finally, reperfusion of the septal branch was accomplished without any angiographic sign of coronary dissection, perforation or shunt. We herein report a rare case of coronary arteriovenous shunt formation due to the dissection and perforation of a coronary artery.
我们描述了一名59岁男性的病例。他首次使用裸金属支架进行经皮冠状动脉介入治疗（PCI）是针对左前降支（LAD）中段90%的狭窄。然而，由于慢性期出现支架内再狭窄，我们进行了再次PCI。在首次对再狭窄病变进行扩张时，使用切割球囊后，从支架支柱发出的间隔支开口处的狭窄加剧。因此，在将选择性导丝插入间隔支后，我们进行了球囊扩张。不幸的是，间隔支发生了冠状动脉夹层和穿孔，还形成了冠状动脉动静脉分流。使用灌注球囊对支架内再狭窄进行额外扩张成功闭塞了间隔支开口，分流血流消失。在仔细重新选择导丝进入间隔支后，然后使用小尺寸传统球囊对穿孔部位进行扩张。最后，间隔支实现了再灌注，没有任何冠状动脉夹层、穿孔或分流的血管造影迹象。我们在此报告一例因冠状动脉夹层和穿孔导致冠状动脉动静脉分流形成的罕见病例。
