DOI QR코드

DOI QR Code

Culotte 스텐팅 기법으로 치료한 좌주간지 침범 자발성 관상동맥 박리증

Treatment of a Spontaneous Coronary Artery Dissection Involving the Left Main Coronary Artery Using the Culotte Stent Technique

  • 이주호 (아주대학교 의과대학 순환기내과학교실) ;
  • 전자영 (아주대학교 의과대학 순환기내과학교실) ;
  • 반가영 (아주대학교 의과대학 순환기내과학교실) ;
  • 강은정 (아주대학교 의과대학 순환기내과학교실) ;
  • 박진선 (아주대학교 의과대학 순환기내과학교실) ;
  • 조대열 (아주대학교 의과대학 순환기내과학교실) ;
  • 최병주 (아주대학교 의과대학 순환기내과학교실)
  • Lee, Joo-Ho (Department of Cardiology, Ajou University School of Medicine) ;
  • Jeon, Ja-Young (Department of Cardiology, Ajou University School of Medicine) ;
  • Ban, Ga-Young (Department of Cardiology, Ajou University School of Medicine) ;
  • Kang, Eun-Jung (Department of Cardiology, Ajou University School of Medicine) ;
  • Park, Jin-Sun (Department of Cardiology, Ajou University School of Medicine) ;
  • Joe, Dai-Yeol (Department of Cardiology, Ajou University School of Medicine) ;
  • Choi, Byoung-Joo (Department of Cardiology, Ajou University School of Medicine)
  • 발행 : 2012.09.01

초록

좌주간지를 침범하는 자발성 관상동맥 박리증은 일반적으로 관상동맥 우회수술로 치료하는 것으로 알려져 있다. 본 증례는 좌주간지 침범 자발성 관상동맥 박리증을 수술하지 않고 culotte 스텐팅 기법을 이용하여 경피적 중재시술로 성공적으로 치료한 예이다.

Spontaneous coronary artery dissection (SCAD) is an extremely rare clinical manifestation of ischemic heart disease. A 43-year-old female was admitted to our hospital for non-ST elevation myocardial infarction. She had no cardiac risk factors except smoking. Coronary angiography showed moderate stenosis of the proximal left circumflex artery (LCX) with intraluminal haziness and a spastic appearance from the culprit lesion in the left main coronary artery (LM). Subsequent analysis by intravascular ultrasound (IVUS) revealed a clear dissection flap from the LCX to the LM. Generally, SCAD of the LM or multivessel involvement requires primary surgical management. The present case was treated percutaneously using the culotte stent technique.

키워드

참고문헌

  1. Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: a Western Denmark Heart Registry Study. Catheter Cardiovasc Interv 2009;74: 710-717. https://doi.org/10.1002/ccd.22115
  2. Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D. Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection. Z Kardiol 1998;87:961-970. https://doi.org/10.1007/s003920050253
  3. McKechnie RS, Patel D, Eitzman DT, Rajagopalan S, Murthy TH. Spontaneous coronary artery dissection in a pregnant woman. Obstet Gynecol 2001;98(5 Pt 2):899-902. https://doi.org/10.1016/S0029-7844(01)01563-0
  4. Verma PK, Sandhu MS, Mittal BR, et al. Large spontaneous coronary artery dissections-a study of three cases, literature review, and possible therapeutic strategies. Angiology 2004; 55:309-318. https://doi.org/10.1177/000331970405500311
  5. Butler R, Webster MW, Davies G, et al. Spontaneous dissection of native coronary arteries. Heart 2005;91:223-224. https://doi.org/10.1136/hrt.2003.014423
  6. Behnam R, Tillinghast S. Thrombolytic therapy in spontaneous coronary artery dissection. Clin Cardiol 1991;14:611-614. https://doi.org/10.1002/clc.4960140714
  7. Nishikawa H, Nakanishi S, Nishiyama S, et al. Primary coronary artery dissection: its incidence, mode of the onset and prognostic evaluation. J Cardiol 1988;18:307-317.
  8. Thistlethwaite PA, Tarazi RY, Giordano FJ, Jamieson SW. Surgical management of spontaneous left main coronary artery dissection. Ann ThoracSurg 1998;66:258-260. https://doi.org/10.1016/S0003-4975(98)00382-8
  9. Tsuchida K, Colombo A, Lefèvre T, et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimuseluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II). Eur Heart J 2007;28: 433-442. https://doi.org/10.1093/eurheartj/ehl539
  10. Windecker S, Serruys PW, Wandel S, et al. Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial. Lancet 2008; 372:1163-1173. https://doi.org/10.1016/S0140-6736(08)61244-1