| Japanese |
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| Title | 胸腔鏡下手術直後にBare Metal Stent内の遅発性血栓症を生じた1症例 |
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| Subtitle | 症例 |
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| Authors | 二木貴弘, 國吉保, 磯脇純和, 永田悦朗, 松永明, 上村裕一 |
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| Organization | 鹿児島大学医学部・歯学部附属病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 30 |
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| Number | 2 |
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| Page | 100-104 |
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| Year/Month | 2009/12 |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 『はじめに』 虚血性心疾患に対する金属ステント(Bare Metal Stent：BMS)は, 2004年に承認された薬剤溶出性ステント(Drug Eluting Stent：DES)に急速に取って変わられつつあるが, 麻酔の現場ではしばしばBMSを留置した患者の症例に遭遇する. ステント留置から間もない場合は抗血小板薬を内服していることが多く, 継続すれば出血のリスクが高まり中止すればステント内血栓症の可能性が生じるため周術期管理においては大きな問題となる. 今回, BMS留置4週間後に全身麻酔下で胸腔鏡下縦隔リンパ節生検を行い, 術直後にステント内血栓症を認めた症例を経験した. 『症例』 患者は77歳の男性. 身長158cm, 体重53kg. 悪性リンパ腫が疑われ胸腔鏡下リンパ節生検目的で入院となった. 高血圧, 脳梗塞の既往があり内服加療中であった. 入院時の血液・生化学検査に異常は認めなかったが, 胸部X線写真では, 心拡大(心胸郭比55%), および左下肺野を中心とした胸水貯留を認めた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | coronary stent, antiplatelet, perioperative management |
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| English |
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| Title | A Case of Late Thrombosis in Bare Metal Stent Immediately after Thoracoscopic Surgery |
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| Authors | Takahiro Futatsuki, Tamotsu Kuniyoshi, Sumikazu Isowaki, Etsurou Nagata, Akira Matsunaga, Yuichi Kanmura |
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| Organization | Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 30 |
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| Number | 2 |
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| Page | 100-104 |
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| Year/Month | 2009/12 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We report a case of late stent thrombosis in the immediate postoperative period of non-cardiac surgery four weeks after a bare metal stent(BMS) implantation. A 77-year old man who was scheduled for thoracoscopic mediastinal lymph node biopsy received preoperatively implantation of BMS for significant stenosis in the proximal left anterior descending coronary artery. The surgery was postponed four weeks after the stent insertion and the dual anti-platelet therapy with aspirin and ticropidine was discontinued one week before the surgery. The surgery was successfully performed under general anesthesia even with episodes of bradycardia and hypotension. Immediately after the surgery, ST-segment elevation in left precordial leads and acute heart failure appeared following a complete atrioventricular block. An emergency coronary angiogram revealed a thrombotic stenosis of the BMS and a restenting restored the stent patency and its hemodynamics. In this case, one of the most important factors causing the stent thrombosis must be discontinuation of antiplatelets. It is very difficult to decide whether to continue antiplatelets or not, because the risk of bleeding or stent thrombosis depends on the type of surgery, stent, and antiplatelets and the time between the stenting and the surgery. Therefore, the issues as stated above should be discussed cautiously among the anesthesiologist, surgeon, and treatment physician. |
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| Practice | Basic medicine |
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| Keywords | coronary stent, antiplatelet, perioperative management |
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