Acute Myocardial Infarction with Simultaneous Occlusion of Two Coronary Arteries Following an Acute Stent Thrombosis in a Patient with Hyperhomocysteinemia: A Case Report

急性支架栓塞後合併急性心肌梗塞及兩條冠狀動脈同時阻塞於高胱胺酸血症之病患－病歷報告

邱俊仁(Chiung-Zuan Chiu) ； 徐國基(Kou-Gi Shyu)

《輔仁醫學期刊》 4卷4期 (2006/12) Pp. 193-201

摘要

高胱胺酸血症為一易導致栓塞之前驅因子，臨床上可造成冠狀動脈心臟病心肌梗塞，深層靜脈栓塞，腦中風，和肺動脈栓塞等疾病。我們報告一位高胱胺酸血症之病患於冠狀動脈氣球擴張術及支架置放後三天發生急性支架栓塞合併急性心肌梗塞及兩條冠狀動脈同時阻塞此為一極為罕見及非常危急之臨床急症。本文除討論包括高胱胺酸血症在內所有可能造成急性支架栓塞的原因外，並探討臨床上如何處理及預防如此罕見之臨床急症。

關鍵字

高胱胺酸血症 ； 冠狀動脈氣球擴張術及支架置放 ； 急性心肌梗塞 ； 急性栓塞

並列摘要

Hyperhomocysteinemia is a prothrombotic disorder that has recently been increasingly recognized Hyperhomocysteinemia itself may increase the incidence of cardiovascular disease, including coronary artery disease, myocardial infarction, deep vein thrombosis, thromboembolic stroke, and a pulmonary embolism. Herein, we report on a 63 year old male who developed sudden onset of severe chest pain 3 days after percutaneous transluminal coronary angioplasty (PTCA) and stenting for the right coronary artery (RCA) and left circumflex coronary artery (LCX). An electrocardiogram showed ST elevation in the inferior lateral leads, and acute myocardial infarction was the impression. Coronary angiography showed acute stent thrombosis and total occlusion of the RCA and LCX. Emergent PTCA and further stenting of the RCA and LCX restored the coronary flow, and the chest pain was relieved Hyperhomocysteinemia, chronic renal insufficiency, and mild depletion of the vitamin B12 level were noted in this patient. We discuss the possible causes of the acute stent thrombosis, including hyperhomocysteinemia, in this patient and the strategy for treating and preventing such a rarely seen critical emergent condition.

並列關鍵字

hyperhomocysteinemia ； percutaneous transluminal coronary angioplasty and stenting ； acute myocardial infarction ； acute thrombosis