Usefulness of fasudil, a rho-kinase inhibitor, to treat intractable severe coronary spasm after coronary artery bypass surgery
Usefulness of fasudil, a rho-kinase inhibitor, to treat intractable severe coronary spasm after coronary artery bypass surgery
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DOI：
10.1097/01.fjc.0000134775.76636.3f
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发表时间：
2004-09-01
影响因子：
3
通讯作者：
Shimokawa, H
中科院分区：
文献类型：
--
作者：
Inokuchi, K;Ito, A;Shimokawa, H
我们最近证实法舒地尔，一种Rho激酶抑制剂，对血管痉挛性心绞痛患者的冠状动脉痉挛有抑制作用。因此，阻断Rho激酶可能为治疗痉挛引起的缺血性冠状动脉综合征提供一种新的治疗策略。严重的冠状动脉痉挛仍然是冠状动脉旁路移植术（CABG）的严重并发症。在这项研究中，我们研究了法舒地尔对CABG后顽固性严重冠状动脉痉挛患者的抑制作用。3例接受CABG的患者显示严重心肌缺血对静脉常规血管扩张剂（包括硝酸异山梨酯（ISDN）、地尔硫卓和尼可地尔）的强化治疗无效。冠状动脉造影显示所有患者的自体冠状动脉和/或旁路移植动脉均出现严重的冠状动脉痉挛。由于冠状动脉内和/或移植物内注射ISDN对缓解痉挛无效，我们随后向痉挛动脉内注射法舒地尔（1.5 mg/min，持续15分钟）。法舒地尔成功地解决了痉挛和改善心肌缺血在所有患者中没有任何全身性的不良反应。总之，与法舒地尔的治疗可能是有用的治疗顽固性和其他致命的冠状动脉痉挛抵抗强化常规血管扩张剂治疗CABG后。
We have recently demonstrated that fasudil, a Rho-kinase inhibitor, is effective in suppressing coronary artery spasm in patients with vasospastic angina. Thus, blockade of Rho-kinase may provide a novel therapeutic strategy to treat ischemic coronary syndrome caused by the spasm. Severe coronary artery spasm still remains a life-threatening serious complication of coronary artery bypass grafting (CABG). In this study, we examined the inhibitory effect of fasudil in patients with intractable severe coronary spasm after CABG.Three patients who underwent CABG showed severe myocardial ischemia resistant to intensive therapy with intravenous conventional vasodilators, including isosoroide dinitrate (ISDN), diltiazem, and nicorandil. Coronary angiography revealed severe coronary spasm in native coronary arteries and/or bypass arterial grafts in all patients. Since intracoronary and/or intragraft administration of ISDN was ineffective to resolve the spasm, we then administered fasudil (1.5 mg/min for 15 minutes) into the spastic arteries. Fasudil successfully resolved the spasm and improved myocardial ischemia in all patients without any systemic adverse effects.In conclusion, the treatment with fasudil may be useful to treat intractable and otherwise fatal coronary spasm resistant to intensive conventional vasodilator therapy after CABG.