21セイキ ノ カンドウミャク インターベンション

Coronary intervention has come to achieve good results with the use of new devices, such as Rotablator (ROTA), new directional coronary atherectomy (DCA), and a special guide wire, even for lesions in which good results were not obtained with plain old balloon angioplasty. In the present study, we evaluated the initial results in patients who underwent ROTA procedures, coronary intervention for chronic total occlusion (CTO), and new DCA procedures in our hospital between January and December 2001. (1) There were 99 patients who underwent ROTA, with an average age of 68±12 years, a lesion length of 15.9±9.9 mm, a reference vessel diameter of 2.7±0.6 mm, and a success rate of 98%. Among these 99 patients, there were 82 patients (83%) with B2 or C type lesion, which is difficult to treat. (2) There were 61 patients with CTO who underwent coronary intervention, with an average age of 63±9 years, an occlusion length of 22.8±13.3 mm, a reference vessel diameter of 2.6±0.7 mm, and a success rate of 82%. (3) There were 5 patients who underwent DCA for ostial lesion of left anterior desending artery and the target lesion was successfully dilated in all these patients. These results indicated that new devices for coronary intervention have made it possible to treat a wider range of lesions, but restenosis still remains to be solved. In Europe and the U.S.A., restenosis is reported to have been drastically reduced by drug eluting stents, which are expected to be introduced in Japan in the future

ジンソクナ バイスタンダー シンパイ ソセイホウ ニヨリ トツゼンシ オ マヌガレ シャカイ フッキ デキタ コウコウセイ ノ 2 ショウレイ

Bystander CPR means that people who find cardiopulmonary arrest perform cardiopulmonary resuscitation on the spot. Quick CPR contributes to increase in the rate of returning to the society as well as one-month survival rate and neurological prognosis. We report our experience with two high school students who underwent quick Bystander CPR, avoided sudden death, and returned to the society. ［Case 1］ Eighteen-year-old man : He collapsed suddenly in his home. Bystander CPR was performed by his family until emergency crews arrived there. Automated external defibrillator （AED） worked twice and his heartbeat started again. In electrocardiogram, coved type ST elevation in lead V1 was observed, and he was diagnosed as Brugada syndrome. We implanted an implantable cardioverter-defibrillator. Since his condition was stable, he was discharged on the 19th day. ［Case 2］ Seventeen-year-old woman : She collapsed suddenly walking with her family. Her father confirmed that she had no response, and started Bystander CPR. Her father got AED quickly and AED worked once, and she started to breathe again. She was admitted to our hospital for a work-up. Torsades de pointes （TdP） was observed in monitor electrocardiogram, and her QTc time was 513 msec in 12‐lead electrocardiogram. She was diagnosed as congenital long QT syndrome because genetic test showed that she had LQT2. Her QTc time was improved （approximately 350 msec） by medication, and she was discharged on the 25th day. Utstein-style statistics in Japan shows that the rate of returning to the society can be doubled by performing Bystander CPR on patients with cardiopulmonary arrest. However, performing rate of Bystander CPR is less than 50％ in Japan. In order to increase survival rate of patients with cardiopulmonary arrest for the future, it is important to inform people about CPR and to promote CPR, and in fact, we have been promoting CPR