Shimizu Ruri, Aoyama Rie, Ishikawa Joji, Harada Kazumasa
Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
J Cardiol Cases. 2021 Dec 31;25(5):319-322. doi: 10.1016/j.jccase.2021.11.014. eCollection 2022 May.
Myocardial ischemia due to narrowing of the right coronary artery (RCA) may result in sinus arrhythmias, which usually present as transient sinus bradycardia with no hemodynamic instability. We report a rare case of sinus arrest with hemodynamic instability, which lasted for several months, and was caused by the occlusion of the sinus node (SN) artery following the RCA stenting. A 78-year-old woman with diabetes mellitus, hypertension, and dyslipidemia was referred to our hospital because of chest pain during activity. In her coronary angiogram, severe diffuse stenosis of the RCA was observed and intracoronary imaging using intravascular ultrasound revealed diffuse atherosclerotic plaque lesions with partial calcification and vulnerability. RCA was treated by inserting three zotarolimus-eluting stents. Immediately after these interventions, the SN artery originating from the RCA proximal to the lesion was occluded, which resulted in SN dysfunction. Significant bradycardia was observed on electrocardiogram along with low blood pressure, suggesting sinus arrest. Along with hemodynamic instability, sinus arrest lasted for several months, and permanent pacemaker implantation was needed. The plaque burden should be taken into consideration when choosing the appropriate percutaneous coronary intervention strategy because of the potential complication of sinus arrest after RCA stenting. < Clinicians should be aware of the potential for sinus arrest after right coronary artery stent implantation. In cases with large plaque burden, it might be best to protect a side branch using a catheter or a small diameter balloon. Acute sinus node ischemia is a possible cause of sinus dysfunction after percutaneous coronary intervention. As such the strategy for this intervention should be chosen with care.>.
右冠状动脉（RCA）狭窄导致的心肌缺血可能会引发窦性心律失常，通常表现为短暂性窦性心动过缓，且无血流动力学不稳定。我们报告了一例罕见的伴有血流动力学不稳定的窦性停搏病例，该情况持续了数月，是由RCA支架置入术后窦房结（SN）动脉闭塞所致。一名患有糖尿病、高血压和血脂异常的78岁女性因活动时胸痛被转诊至我院。在她的冠状动脉造影中，观察到RCA严重弥漫性狭窄，血管内超声进行的冠状动脉内成像显示弥漫性动脉粥样硬化斑块病变，伴有部分钙化和易损性。通过植入三个佐他莫司洗脱支架对RCA进行了治疗。这些干预措施后立即发现，起源于病变近端RCA的SN动脉闭塞，导致SN功能障碍。心电图显示显著心动过缓并伴有低血压，提示窦性停搏。除血流动力学不稳定外，窦性停搏持续了数月，需要植入永久性起搏器。由于RCA支架置入术后存在窦性停搏的潜在并发症，在选择合适的经皮冠状动脉介入治疗策略时应考虑斑块负荷。<临床医生应意识到右冠状动脉支架植入后发生窦性停搏的可能性。在斑块负荷较大的情况下，最好使用导管或小直径球囊保护侧支。急性窦房结缺血是经皮冠状动脉介入治疗后窦房结功能障碍的可能原因。因此，应谨慎选择该介入治疗的策略。>
