[A patient undergoing surgery for gastric cancer four weeks after insertion of a drug-eluting coronary stent].

We report a patient who underwent gastrectomy four weeks after a coronary stent insertion. A 79-year-old man suffering from unstable angina was transferred to our hospital and a sirolimus-eluting coronary stent was inserted into his right coronary artery. The day after receiving the coronary stent, the patient began vomitting bloody gastric fluid. Endoscopic findings showed Borrmann type 3 gastric cancer and a distal partial gastrectomy was scheduled four weeks after stent insertion. One week before the operation, the patient's aspirin and ticlopidine regimen was replaced with heparin injection, which was then discontinued twelve hours before the operation. After confirmation that his activated coagulation time was normalized, an epidural catheter was inserted and anesthesia was induced with midazolam 3.0 mg, fentanyl 0.1 mg and vecuronium 7.0 mg. Then propofol administration was began with a simulated blood concentration of 2 microg x ml(-1). Anesthesia was maintained using propofol infusions and intermittent epidural injections of local anesthetics. Hypotension was treated using an infusion of dopamine. The surgery was successfully performed and the patient was intensively monitored in the ICU. Heparin was restarted three days after the operation, and replaced with antiplatelet therapy five days after the operation. Six months after his gastrectomy, the patient underwent a right colon resection for invasive carcinoma. No complication, such as stent thrombosis or bleeding, occurred during the perioperative period.