急性冠脉综合征PCI后脑出血并亚急性支架内血栓1例报告及文献复习

Cerebral hemorrhage accompanying sub-acute stent thrombosis in patient with acute coronary syndrome following percutaneous coronary intervention:A case report and review of the literature

目的探讨急性冠脉综合征(ACS)血栓与出血并发症的处理策略。方法对1例ACS经皮冠脉介入治疗(PCI)后并发脑出血及亚急性支架内血栓患者的临床资料进行回顾性分析,并复习相关文献。结果患者男性,76岁,ACS,冠脉造影3支病变(狭窄>50%)。常规双联抗血小板、抗凝及早期PCI,术后并发脑出血,暂停抗栓药后亚急性支架内血栓形成,再次急诊PCI。术后积极治疗并发症,加用抗栓药物,密切监测出凝血,于第37天好转出院。结论平衡血栓与出血风险是ACS治疗的关键。依据风险评估及时调整治疗方案,能够预防和降低并发症的发生。

Objective To study the management strategy of thrombosis accompanying cerebral hemorrhage in patients with acute coronary syndrome（ACS）.Methods Clinical data about 1 patient with ACS accompanying cerebral hemorrhage and sub-acute stent thrombosis following percutaneous coronary intervention（PCI） were retrospectively analyzed with related literature reviewed.Results The ACS patient was a 76-year old male.Coronary angiography showed 3 lesions in coronary artery with a stenosis 50%.Cerebral hemorrhage occurred following PCI with dual anti-platelet and anti-thrombin agents.The patient underwent emergency PCI due to sub-acute stent thrombosis after withdrawal of anti-thrombotic agents and he was discharged from hospital 37 days after active treatment of complications by adding antithrombotic agents and monitoring coagulation.Conclusion The key to the treatment of ACS is to balance the thrombosis and hemorrhagic risk.Assessment of risk and adjustment of treatment pan can prevent and reduce the incidence of complications.