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目的分析近期临床应用冠脉药物洗脱支架(drug-eluting stent,DES)术后,晚发的支架内急性血栓形成病例的发生特点及可能影响因素。方法应用关键词:coronary artery、sirolimus、paclitaxil、drug-eluting stent、thrombosis,anuerysm、malapposition等,应用美国国立医学图书馆的PubMed系统和德国海德堡大学的电子期刊系统对临床医学核心期刊进行系统检索。对检索出的12个病例及本中心3例冠状动脉内置入DES后晚发支架内急性血栓形成病例汇总分析。结果共有15例患者,在DES(sirolimus和paclitaxel支架)术后出现晚发的支架内急性血栓形成和(或)同时合并冠脉瘤样扩张、支架与血管壁贴合不良(malapposition)。急性血栓发生时间:120~540天。9例患者在停用阿司匹林、氯吡格雷后4~15天发生;3例患者在DES置入部位出现明显冠脉瘤样扩张和(或)瘤腔内血栓形成;4例患者在DES发生急性血栓时、同时置入的6枚普通金属支架完全通畅。结论晚发的DES内急性血栓形成(≥6个月)、支架与血管壁贴合不良、明显的冠脉管壁瘤样扩张造成再次严重的心肌缺血或梗死。
Objective To analyze the occurrence characteristics and possible influencing factors of intra-stent acute thrombosis after the recent clinical application of drug-eluting stent (DES). METHODS: Key words: coronary artery, sirolimus, paclitaxel, drug-eluting stent, thrombosis, anuerysm, malapposition and so on. The PubMed system of the National Library of Medicine and the electronic journal system of Heidelberg University were used to search the core journals of clinical medicine systematically. A total of 12 cases were retrieved and the cases of acute thrombosis in the late stent were retrospectively analyzed. Results A total of 15 patients underwent late stent thrombosis and / or concurrent aortic aneurysmal dilation after DES (sirolimus and paclitaxel stents) with malapposition of the stent to the vessel wall. Acute thrombosis time: 120 ~ 540 days. Nine patients discontinued aspirin, clopidogrel 4 to 15 days after the occurrence of; 3 patients in the DES site significant coronary aneurysm-like dilation and (or) tumor thrombus formation; 4 patients with acute DES Thrombosis, while placing the 6 common metal stent completely open. Conclusions Acute thrombosis in the late onset of DES (≥6 months) results in a poor fit of the stent to the vessel wall, and a significant expansion of the aneurysm of the coronary artery resulting in a subsequent severe myocardial ischemia or infarction.