急性心肌梗死后冠状动脉未完全机化血栓病变——“凝胶状”表现的影像特点及介入治疗

The Characteristic of Coronary Angiography and the Techniques of Percutaneous Coronary Intervention of the Gel-like Coronary Thrombotic Lesions in Patients with Acute ST-segment Elevation Myocardial Infarction

目的探讨急性心肌梗死后部分梗死相关动脉内呈＂凝胶状＂表现的未完全机化血栓病变患者的临床、影像和介入治疗特点。方法收集住院行冠状动脉造影显示梗死相关动脉内呈＂凝胶状＂表现的未完全机化血栓病变的6例患者的临床资料、影像资料,进行总结分析,探讨其规律特点。结果 6例患者入院前均诊断为急性ST段抬高型心肌梗死,梗死相关动脉均为右冠状动脉。心肌梗死发病距冠状动脉造影时间为1-3周。影像学和介入治疗特点为：梗死相关动脉100%闭塞;导丝通过后仍为TIMI 0-1级血流;球囊扩张后血流改善不明显;支架置入后血流全部为TIMI 3级;吸栓和ⅡbⅢa受体拮抗剂效果差。结论该类病变为ST段抬高型心肌梗死患者梗死相关动脉内未完全机化的血栓病变,多发生在心肌梗死后1-3周,右冠状动脉多见。

Aim To summarize the clinical manifestation and the characteristic of coronary angiography of patients with the gel-like coronary thrombotic lesions,and to explore the experiences and technique of percutaneous coronary intervention（ PCI） for the peculiar coronary lesions. Methods The data was retrospectively analyzed from 6 patients with the gel-like coronary thrombotic lesions. Results Six patients were diagnosed as acute ST-segment elevation myocardial infarction（ STEMI）,and the infarction related arteries（ IRA） were all right coronary artery. They received selectively PCI one to three weeks after heart attack. Coronary angiography revealed that total occlusion and thrombus occurred in IRA,accompanied with antegrade blood flow of grade TIMI 0. But,the antegrade blood flow in IRA remained the level of grade TIMI 0 - 1 after guide wires pass through the occlusion. Predilation failed to improve markedly the level of antegrade blood flow,and so did not thrombus aspiration and tirofiban. However,the IRA got antegrade blood flow of grade TIMI 3 after the stent implantation. Conclusion The gel-like coronary thrombotic lesions in IRA results from undissolved and partly fibrotic thrombus after myocardial infarction,and commonly occurs in right coronary artery.