支架内血栓形成病例的临床特点分析

Clinical Characteristic Analysis of Stent Thrombosis After Percutaneous Coronary Intervention

目的:分析支架内血栓形成病例的临床特点并探讨其原因。方法:收集自2007-04至2008-06的所有支架内血栓的患者,共12例。其中男性10例,女性2例。1例置入金属裸支架,其余11例均为药物涂层支架。分析入选病例的临床特点,冠状动脉病变特征。结果:12例患者中,亚急性血栓5例;晚期血栓4例;极晚期血栓3例。分析病变特点及血栓形成原因显示:在早期血栓形成的5例中4例为原发性支架贴壁不良、支架膨胀不良、未完全覆盖病变;1例为糖尿病、长病变、完全闭塞病变。在晚期和极晚期血栓形成的7例病例中3例因为停用了波立维;2例有支架内严重再狭窄;1例为正性重构、获得性贴壁不良;1例为糖尿病、小血管病变,且支架中段扩张不充分不除外贴壁不良的因素。结论:支架内血栓是金属裸支架和药物涂层支架置入术后很少发生但非常严重的并发症。急性的支架内血栓可能与贴壁不良有关。晚期支架内血栓在病因学上是多因素的,主要与双联抗血小板药物治疗依从性相关。

Ohjective：To analyze the clinical characteristics of stent thrombosis （ST） after pereutaneous coronary intervention （PCI） and to investigate the possible cause and the risk factors of ST. Methods：A total of 12 angiographic diagnosed ST patients from April 2007 to June 2008 were analyzed that including 10 males and 2 females. One patient was implanted with bare-metal stent （BMS） ,others were with drug-eluting stents （DES）. Results ：There were 5 patients suffered from sub-acute ST, 4 suffered from late ST and 3 from very late ST. Among 5 early ST patients, primary real-apposition was found in 4 cases and stent overlap of the long lesion,chronic total occlusion lesion with diabetes was found in 1 case. For late and very late ST patients,the cause of discontinuation of Plavix medication in 3 patients , restenosis in 2 patients,secondary mal-apposition in 1 patient and small vessel,under expansion with diabetes in 1 patient. Conclusion ： ST was an infrequent but severe complication of both BMS and DES. Sub-acute ST might he caused by malapposition, late ST could be multi-factorial in etiology, the primary reason could be related to the compliance of dual antiplatelet therapy.