Watanabe Keisuke, Nakamura Natsuki, Kikuta Koichi, Matsubara Junichi, Okuyama Eisaku, Katayama Tetsuji
Division of Cardiology, Shinbeppu Hospital, 3898 Ooaza Tsurumi, Beppu City, Oita 874-0833, Japan.
J Cardiol Cases. 2009 Nov 8;1(1):e33-e36. doi: 10.1016/j.jccase.2009.06.006. eCollection 2010 Feb.
A 56-year-old woman with hypertension and hypercholesterolemia was admitted to our hospital with acute inferior myocardial infarction. The patient had total occlusion of the right coronary artery (RCA) segment 2, and bare-metal stents were placed. Four months later, plain old balloon angioplasty was performed for in-stent restenosis. Follow-up coronary angiography (CAG) 6 months later showed in-stent total occlusion, so a stent-in-stent procedure was performed using paclitaxel-eluting stents (PESs). Four months later, the patient began complaining of early morning chest pain at rest. CAG showed no in-stent restenosis, so coronary spastic angina was suspected. Intracoronary infusion of ergonovine to the right and left coronary arteries revealed spasm of the RCA with total occlusion just proximal to the PES in segment 1. Her chest pain was reproduced with ST-elevation in leads II, III, and aVF, so the diagnosis of coronary spastic angina was made. Treatment with a Ca-channel blocker and nitrates relieved the symptoms. The PES was the probable cause of the coronary spasm.
一名患有高血压和高胆固醇血症的56岁女性因急性下壁心肌梗死入住我院。患者右冠状动脉（RCA）第2段完全闭塞，植入了裸金属支架。四个月后，对支架内再狭窄进行了普通球囊血管成形术。6个月后的随访冠状动脉造影（CAG）显示支架内完全闭塞，因此使用紫杉醇洗脱支架（PES）进行了支架内支架置入术。四个月后，患者开始抱怨清晨静息时胸痛。CAG显示无支架内再狭窄，因此怀疑为冠状动脉痉挛性心绞痛。对左右冠状动脉进行麦角新碱冠状动脉内注射显示，RCA在第1段PES近端出现痉挛并完全闭塞。其胸痛在II、III和aVF导联出现ST段抬高时再现，因此诊断为冠状动脉痉挛性心绞痛。使用钙通道阻滞剂和硝酸盐治疗缓解了症状。PES可能是冠状动脉痉挛的原因。
