Pimentel Filho W A, Alfaia W, Büchler J R, Assis S F, Armelin E
Hospital da Real e Benemérita Sociedade Portuguesa de Beneficência, São Paulo.
Arq Bras Cardiol. 1997 Mar;68(3):189-92.
White woman 46 years old was admitted with oppressive rest angina. Two months prior, she had been submitted to a coronary artery bypass surgery: saphenous vein graft to the left anterior descending coronary; left internal mammary artery to the 1st diagonal branch and a radial artery as a free artery graft, to the biggest branch of the left circumflex artery. On coronary angiography, both the saphenous vein and the radial artery were occluded, with patency of the left internal mammary artery. The patient underwent coronary angioplasty with a Palmaz-Schatz stent 3.0/15 mm implantation in the left main coronary artery and was submitted to a high-pressure balloon inflation. She was discharged free of angina from the hospital and one month later retrosternal chest pain recurred. On coronary angiography a restenosis in the left main coronary was seen. Repeat coronary angioplasty with high-pressure balloon inflation technique and with intravascular ultrasound guidance was done. Larger balloons and progressive higher-pressure balloon inflations were used until reaching a stent internal lumen greater than the reference distal diameter. The patient was asymptomatic at four months of follow-up.
46岁白人女性因压榨性静息性心绞痛入院。两个月前，她接受了冠状动脉搭桥手术：大隐静脉移植至左前降支冠状动脉；左乳内动脉至第一对角支，桡动脉作为游离动脉移植至左旋支冠状动脉最大分支。冠状动脉造影显示，大隐静脉和桡动脉均闭塞，左乳内动脉通畅。患者在左主干冠状动脉植入了一枚3.0/15毫米的帕尔马兹-沙茨支架并进行了冠状动脉成形术，随后接受了高压球囊扩张。她出院时无心绞痛症状，一个月后胸骨后胸痛复发。冠状动脉造影显示左主干冠状动脉再狭窄。在血管内超声引导下，采用高压球囊扩张技术再次进行冠状动脉成形术。使用了更大的球囊并逐渐增加球囊扩张压力，直至支架内腔大于参考远端直径。随访四个月时患者无症状。
