导管血栓抽吸联合冠脉支架置入治疗急性心肌梗死临床观察

Clinical observation for treatment of acute myocardial infarction by stent implantation combining with catheter aspiration coronary thrombus

目的观察导管血栓抽吸联合冠脉支架置入治疗急性心肌梗死(AMI)疗效。方法对122例AMI冠脉支架置入治疗病人中的43例急性ST段抬高型AMI(STEMI)患者常规进行冠脉造影术后,确定梗死相关动脉(IRA),见闭塞病变近端均有大量血栓征象。先用DiverCE装置血栓抽吸导管抽吸血栓,再使用球囊扩张狭窄病变并置入支架,或抽吸后直接置入支架。观察置入支架前后TIMI血流、缺血性胸痛缓解、心电图ST段回落情况,并用超声心动图评估左心室射血分数。结果 43例病人术前冠脉造影显示IRA的前向血流TIMI0级38例,TIMI1级4例,TI-MI2级1例。经导管反复血栓抽吸,31例抽出不同量的肉眼血栓,抽吸后造影显示IRA的前向血流TIMI3级26例,TIMI2级15例,TIMI1级2例,与术前比较TIMI血流明显改善(P<0.01)。术后1h内缺血性胸痛完全缓解;经皮冠状动脉介入治疗(PCI)术后1h复查心电图,缺血明显改善,ST段回落率>70%;术后1个月超声心动图评估左心室射血分数为(52.00±5.63)%;临床随访6个月～1年,1例术后支架内再狭窄,42例病人无主要不良事件(死亡、再梗死、靶血管重建、卒中等)发生。结论 STEMI患者实施PCI术前采用DiverCE装置导管血栓抽吸术可去除血栓负荷,改善心肌组织的再灌注,提高PCI的实际成功率,该手术具有简便易行、有效且相对价格较低的优点。

Objective To observe the efficacy of treatment combining stenting with catheter aspiration coronary thrombi in patients with acute myocardial infarction （AMI）.Methods In 122 AMI patients underwent percutaneous coronary intervention （PCI）,43 patients with acute ST-elevation AMI （STEMI）,whose coronary angiography showed presence of accumulated thrombi proximal to the occlusion,were treated by stenting combining catheter aspiration coronary thrombi.After confirming infarct-related artery （IRA）,adjunctive dethrombosis by catheter aspiration using Diver CE device was performed before PCI.Thereafter,balloon was placed to dilate narrow lesion,then stent was implanted,or the stent was directly implanted after aspiration.The thrombolysis in myocardial infarction （TIMI） flow grade,situation of chest pain,the magnitude of ST-segment resolution of ECG and left ventricular ejection fraction （LVEF） by echocardiography were observed and assessed before and after PCI.Results The TIMI flow grades of IRA forward flow were TIMI 0 in 38 cases,TIMI 1 in 4 case and TIMI 2 in 1 case before PCI.After repeated aspiration of coronary thrombi by catheter,the naked eye coronary thrombi were aspirated out from 31 cases. After PCI,the TIMI flow grade 3 of IRA was seen in 26 cases,TIMI 2 in 15 cases,and TIMI 1 in 1 case.The TIMI flow grades before and after PCI existed obvious difference （P0.01）.One hour after PCI,ischemic chest pain was totally recovered,and ST-segment resolution was more than 70% by re-checking ECG.One month late after PCI,LVEF was increased 〔（52.00±5.63）%〕.Clinical follow-up was performed for 6 months to 1 year.In-stent restenosis happened in 1 case,and no major adverse events （death,re-infarction,target vessel reconstruction,apoplexy,etc） happened in other 42 cases.Conclusions Adjunctive thrombectomy using Diver CE device to remove thrombi burden before stenting may improve myocardial reperfusion and raise success rate of PCI in reality for STEMI patients,and this procedure has advantages of easiness,safety,effectiveness and low-expenditure.