摘要
目的探讨药物洗脱支架植入后早期支架内血栓形成的特点、形成因素及治疗措施。方法对16例急性冠脉综合征植入药物洗脱支架后发生支架内血栓的患者进行回顾性研究。结果多支病变14例(87.50%),急性心肌梗死6例(37.50%),血栓形成相关动脉为左前降支(LAD)者12例(75.00%),存在抗凝药物使用不充分的情况为3例(18.75%,主要为漏服或停用氯吡格雷所致)。术中8例(50.00%)出现夹层或残余狭窄>20%,平均植入支架(1.85±0.77)个,靶血管平均植入支架(1.42±0.65)个,平均长度为(36±8.67)mm,平均直径为(2.71±0.14)mm。支架内血栓形成发生于支架植入后5 min至10 d[平均(3.1±4.4)d]。血栓形成后15例应用盐酸替非罗斑后,溶栓4例,再次PCI 9例,室颤8例,低血压状态1例,死亡2例(12.5%)。结论多支病变、急性心肌梗死、左前降支病变、抗血小板不充分、术中出现夹层或较重残余狭窄、小血管、长病变等为支架内血栓形成的高危因素。支架内血栓形成是介入术后的严重并发症,预后差,死亡率高,再次介入治疗是有效的抢救手段。
Objective To investigate the characteristics,risk factors and treatment of early thrombosis formation within drug-eluting stent after drug-eluting stent implantation.Methods The characteristics,risk factors and treatment of early stent thrombosis formation were analyzed in 16 patients with acute coronary syndrome treated with drug-eluting stent implantation.Results Multi-vessels involvement was detected in 14 patients,AMI occurred in 6 patients,while target lesions of left anterior descending artery（LAD） were found in 12 patients,including 3 patients receiving noneffective anti-platelet treatment.The in-stent thrombosis occurred 5 min to 10 d [mean（3.1±4.4） d] after percutaneous coronary intervention（PCI）.Ventricular fibrillation happened in 8 patients,hypotension developed in 1 patient,and 2 died.Emergent PCI were performed in 9 patients.Conclusion The risk of developing in-stent thrombosis is high in patients with muulti-vessels involvement,AMI,target lesions on LAD,noneffective anti-platelet treatment,small vessel and long lesion.Emergency PCI is the most effective method and should be carried out as early as possible in order to improve the outcome of in-stent thrombosis.
出处
《中国介入影像与治疗学》
CSCD
2009年第5期432-434,共3页
Chinese Journal of Interventional Imaging and Therapy
关键词
冠状动脉疾病
支架
血栓
Coronary disease
Stent
Thrombosis
