Koiwaya Y, Ishikawa T, Nakagawa S, Ochiai H, Tanaka K
Arch Intern Med. 1985 May;145(5):943-5.
A 55-year-old man developed acute inferior myocardial infarction. A coronary arteriogram performed within two hours later showed complete occlusion of the right coronary artery, which was not resolved by two doses of 300 micrograms of intracoronary nitroglycerin. It was recanalized with 50% luminal diameter narrowing after 600,000 units of urokinase. Immediately after this thrombolytic therapy, the patient experienced chest pain, and the coronary artery became completely obstructed again. The pain was promptly relieved by 300 micrograms of intracoronary nitroglycerin, with disappearance of the obstruction. The observations during the procedure indicate that coronary artery spasm can occur after successful thrombolytic therapy on an occluded artery, inducing postinfarction angina, and might culminate in a second complete occlusion after percutaneous transluminal coronary recanalization.
一名55岁男性发生急性下壁心肌梗死。两小时后进行的冠状动脉造影显示右冠状动脉完全闭塞，冠状动脉内注射两剂300微克硝酸甘油未能使其再通。给予60万单位尿激酶后血管再通，管腔直径狭窄50%。在这种溶栓治疗后，患者立即出现胸痛，冠状动脉再次完全阻塞。冠状动脉内注射300微克硝酸甘油后疼痛迅速缓解，阻塞消失。手术过程中的观察结果表明，在成功溶栓治疗闭塞动脉后可能发生冠状动脉痉挛，诱发梗死后心绞痛，并可能在经皮腔内冠状动脉再通后导致再次完全闭塞。
