Successful use of endothelial progenitor cell capture stents in a coronary artery disease patient with aspirin hypersensitivity who failed initial aspirin desensitization.

摘要

A 56-year-old man with history of G6PD deficiency and aspirin-induced asthma presented with acute coronary syndrome. He complained of sudden onset of chest pain on the day of admission. Electrocardiography revealed dynamic ST changes in lead V1 and V2; troponon-I level was elevated at 7.05 ng/mL (normal: <0.04 ng/mL); creatinine phosphokinase level was normal. His clinical condition was stabilized with a course of subcutaneous injection of low-molecular-weight heparin (LMWH), clopidogrel, and statin. He was intended for elective coronary intervention 2 weeks after the acute event. Two days prior to intervention, he was scheduled for an aspirin desensitization protocol. A written consent was signed after thorough explanation of the nature, benefit and risk of the procedure. Aspirin was prescribed in escalating doses, starting from 1 mg, 2 mg, 5 mg, 10 mg, 20 mg, 40 mg, and 80 mg every 30 minutes without steroid cover. Vital signs were closely and continuously monitored throughout the procedure inside the coronary care unit. However, at the fifth dose of aspirin (20 mg), patient developed sinus bradycardia (43 beats per minute) and hypotension (60/35 mmHg). In view of possible anaphylactic reaction, the protocol was immediately terminated. Patient was successfully resuscitated after vigorous fluid administration and intravenous atropine injection; no bronchospasm or skin rash was developed.