药物洗脱支架术后急性亚急性血栓发生的原因及救治分析

Analysis of the factors and treatment of the acute and subacute thrombosis in the coronary drug-eluting stent

目的：分析冠状动脉药物洗脱支架（drug-eluting stent， DES）置入术后支架内急性、亚急性血栓形成的原因及救治措施。方法回顾性分析2007-12～2012-12我院心脏内科冠心病患者行DES置入术后43例患者发生急性、亚急性血栓的时间、部位、因素及救治措施。结果①DES置入术5320例，术后发生支架内急性、亚急性血栓43例，发生率0．81％，死亡9例，死亡率20．93％。血栓形成时间0．25～11（4．2＆#177;4．6） d。②发生部位：左前降支33例，左回旋支3例，右冠状动脉7例；病变类型：B/C型39例， A型4例；发生血栓的血管直径：2．5 mm 19例，3．0 mm 22例，3．5 mm 2例。靶血管的支架数及长度：2枚以上38例，平均直径及总长度（2．87＆#177;0.40）mm ＆#215;（32．39＆#177;7．72）mm；1枚5例，平均（3．18＆#177;0．39）mm ＆#215;（19．87＆#177;4．66）mm。③原因：贴壁不良19例，小血管长病变14例，支架近远端过度扩张致内膜撕裂5例，氯吡格雷抵抗3例。④救治措施：采用直径略大的球囊高压扩张血栓部位35例，支架近远端再置入一枚支架5例。结论血栓形成主要与血管病变特点、球囊扩张后血管损伤程度、支架直径和长度、氯吡格雷抵抗等因素有关，多发生在糖尿病、高血压病、多支血管病变、前降支病变、弥漫复杂病变患者；急诊再次介入治疗是救治的首要措施。

Objective To analyze the Factors and treatment of the acute and subacute thrombosis in the coronary drug -eluting stent （ DES ） and to evaluate the efficacy of the emergent percutaneous coronary intervention （PCI）for it.Methods baseline and follow-up data of 5320 patients who underwent PCI and implanted DES in our hospital from December 2007 to December 2012 , in which 43 patients suffered from acute and subacute thrombosis Results ①43 acute and subacute coronary in-stent thrombosis was confirmed in 5320 patients （ 0.81%） and 9 patients died （ mortality 20.93%）.The thrombosis occurred from 6 hours to 11 days after PCI （4.2 ＆#177;4.6）d.②Target vessel of the thrombosis：33 in the left anterior descending artery （LAD）, 3 in the left cicumlex artery（LCX） and 7 in the right coronary artery （ RCA）;The lesions type：39 cases were type B/C and 4 cases were type A;Artery diameter of thrombosis：19 in 2.5 mm,22 in 3.0 mm and 3 in 3.5 mm artery respectively;The length and the number of the stents in the target vessel：38 were more than 2 stents （2.87 ＆#177;0.40） mm ＆#215;（32.39 ＆#177;7.72） mm and 5 were only one stent （3.18 ＆#177;0.39） mm ＆#215;（19.87 ＆#177;4.66） mm.③Among the 43 cases, 19 caused by stent malapposition , 14 by small vessel and long lesion , 5 by endothelial tear of overdistension and 3 by clopidogre resistant .④35 patients were treated by high pressure balloon dilatation and 5 patients were treated by planting more stent .Conclusion The risk＆amp;nbsp;factors of developing in -stent thrombosis were lesion type , intervention operating factors , the length and diameter of the stents and clopidogre resistant . It occurred higher in patients with diabetes , hypertension ,multi-vessel disease , target lesion in LAD and suffuse lesion .Emergency PCI are the most effective methods for treating acute and subacute thrombosis .