血管内超声诊断支架断裂的临床价值——附2例报道及文献复习

Clinical value of intravascular ultrasound in diagnosing stent fracture: report of two cases with literature review

支架断裂是药物洗脱支架失败的一种表现。本文报道2例经冠状动脉造影和血管内超声明确诊断的5处支架断裂。2例患者均植入多枚支架且复查造影发现多处支架断裂。5处支架断裂均发生在西罗莫司药物洗脱支架。冠脉造影中3处支架断裂为完全断裂伴断裂处支架移位。血管内超声(IVUS)证实,3处支架断裂为完全断裂,2处为部分断裂,1处断裂靠近支架重叠处,1处支架断裂伴有血管瘤形成。冠脉造影和IVUS可以帮助确定支架断裂的诊断并探讨其发生机制。

Stent fracture has been implicated as a cause of drug-eluting stent failure. The authors report here 2 cases with stent fractures which were diagnosed by coronary artery angiography and intravascular ultrasound （IVUS）. Both of them received multiple-stent-implantation. Five stent fractures altogether were detected in two patients. All the involved stents were sirolimus-eluting ones. Angiographic study showed that three stent fractures were complete transverse linear fracture with stent displacement. IVUS demonstrated that three stent fractures were complete break and two were partial break. One fracture was located close to the overlapping site of two stents and another fracture was accompanied by the formation of a coronary aneurysm. Angiography and IVUS are helpful to identify stent fracture. In addition, IVUS is more likely to clarify the cause of stent failure as well as the mechanism of stent fracture.