Kunisov sindrom i rana tromboza stenta

  • Tomislav Kostić University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Zoran Perišić University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Dušanka Kutlešić Kurtović University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Bojan Maričić University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Svetlana Apostolović University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Dragana Stanojević University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Goran Koraćević University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Sonja Dakić University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Nenad Božinović University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Katarina Kostić University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Jelena Milošević University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
  • Mihajlo Lazarević University Clinical Center Niš, Clinic for Cardiology, Niš, Serbia
Ključne reči: angioplastika, translumenska, angiografija koronarnih arterija, koronarna bolest, hipersenzibilnost, kunisov sindrom

Sažetak


Uvod. Kunisov sindrom je istovremena manifestacija akutnog koronarnog sindroma i stanja udruženih sa aktivacijom mastocita, kao što su alergija i anafilaktička reakcija. Prikazujemo slučaj rane tromboze stenta kod žene sa atopijskom konstitucijom, bez prethodnog postojanja aterosklerotskih lezija. Prikaz bolesnika. Pedesetogodišnja žena sa tipičnim anginoznim bolom primljena je na Kliniku za kardiologiju Univerzitetskog kliničkog centra u Nišu. Nekoliko sati ranije, ona je prošla pored drveta lipe u cvetanju. Odmah je osetila bol u grudima, parestezije i utrnulost leve ruke, stezanje u grlu, otežan jezik i otok usana. Tegobe su prestale tokom 60 min nakon uzimanja 10 mg loratadina, ali su se ponovo javile. Na elektrokardiografskom (EKG) nalazu, 30 min nakon prijema, viđena je ST elevacija u odvodima D2, D3, aVF i V6. Urađena joj je perkutana koronarna intervencija. Angiogram je pokazao okluzivnu trombozu ostijalnog dela prednje silazne grane leve (left anterior descending – LAD) koronarne arterije. Plasiran je sirolimusom obložen stent i postignut thrombolysis in acute myocardial infarction TIMI 3 protok. Nekoliko sati nakon intervencije, bolesnica je prijavila da ponovo oseća bol u grudima, što je bilo praćeno ventrikularnom fibrilacijom (VF), DC šokom i pojavom elevacije ST segmenta u aVR i V1–V3 na EKG-u. Ponovljena angiografija je pokazala akutnu in-stent trombozu sa okluzijom. Urađena je balon angioplastika kojom je obnovljen TIMI 3 protok u LAD koronarnoj arteriji. Primenjena je antikoagulantna i kortikosteroidna terapija. Tri dana nakon intervencije, urađena je optička koherentna tomografija, koja je pokazala dobru ekspanziju stenta i apoziciju, bez ateroskleroze i tromboze. Zaključak. Koronarografijom je dokazan tip I Kunisovog sindroma nakon ekspozicije alergenu i tip III Kunisovog sindroma ubrzo nakon postavljanja stenta, kada je nastala akutna in-stent tromboza. Novoopisani uzroci akutne i subakutne tromboze stenta kod Kunisovog sindroma tipa III su hipersenzitivne reakcije povezane sa stentom.

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Objavljeno
2023/12/29
Rubrika
Prikaz bolesnika