ST段抬高型心肌梗死介入治疗是否选择血栓抽吸的思考

Thinking of Selective Thrombus Aspiration in Interventional Treatment of ST-segment Elevation Myocardial Infarction

是否对ST段抬高型心肌梗死(STEMI)患者行血栓抽吸存在较大争议,目前经皮冠状动脉介入治疗(PCI)术中支架植入前已不再推荐常规机械血栓抽吸,只是在血栓负荷较重时推荐使用。罪犯血管的病理基础、血栓的成分、血栓负荷及血管内膜的完整性是行血栓抽吸术的影响因素,通过对STEMI病变冠脉血管的病理特征及血栓成分进行分析,提出对STEMI患者是否行血栓抽吸的临床策略。

Thrombus aspiration in patients with ST-segment elevation myocardial infarction(STEMI)is a controversial theme.Conventional mechanical thrombus aspiration before the stenting is no longer recommended in percutaneous coronary interven-tion(PCI),which instead it is only recommended if the thrombus is too large or too numerous.Whether the thrombus aspiration should be applied depends on the pathological changes of the culprit arteries,composition and the severity of the thrombus,and the integrity of the coronary arteries.Based on the analysis of pathological features and thrombotic compositions of coronary arteries in pa-tients with STEMI,whether thrombotic aspiration strategy should be performed for STEMI patients is proposed.