冠状动脉支架内急性亚急性血栓形成的诊治体会

目的探讨冠状动脉支架内急性亚急性血栓形成的原因和处理方法。方法回顾性分析我院开展冠脉介入手术以来发生的诊断明确的冠脉支架内急性亚急性血栓形成的5例患者的病历资料。结果 9年间总共有928例患者行冠脉介入手术,共发生冠脉支架内急性亚急性血栓形成5例,发生率0.54%。冠脉支架内急性亚急性血栓形成与冠脉血管病变长,严重钙化病变,血管细小,支架膨胀不全,支架贴壁不良,支架未完全覆盖病变,支架重叠连接处未重整,术后未坚持应用双联抗血小板药物及抗血小板药物抵抗有关。冠脉支架内急性亚急性血栓形成对溶栓效果不佳,需急诊行PTCA、血栓抽吸导管开通相关血管,并强化抗凝抗血小板治疗。结论冠脉支架内急性、亚急性血栓形成与患者血管病变特点及介入操作等因素有关。再次急诊PTCA、血栓抽吸导管开通相关血管是治疗支架内血栓形成的首选方法。

Diagnosis and treatment of subacute thrombosis in coronary drug-eluting stent

Objective To study the pathogenesis and therapy of subacute thrombosis（SAT） in coronary stents after percutaneous coronary intervention.Methods The clinical data of 5 patients who were diagnosised clearly subacute thrombosis was analyzed.Results We reviewed 928 patients who underwent percutaneous coronary intervention（PCI） from 2002 to 2011,5 subacute coronary in-stent thrombosis were confirmed,the incidence of SAT was 0.54%.SAT may be related to long deno lesions,vessel calcification,lesions in small vessels,stent underexpansion,incomplete stent apposition,no treatment for the gap between two stents,discontinuation of antiplatelet therapy,drug resistance.Thombolysis was not effective to SAT.SAT needed emergent PTCA,aspiration and enchantment of antiplatelet therapy.Conclusion The risks of developing in-stent thrombosis were lesion type and intervention operating fators,Emergent PTCA and aspiration are the most effective methods for treating in-stent thrombosis.