冠状动脉支架内二次血栓形成的原因分析

目的:探讨冠状动脉支架内二次血栓形成(ST)的相关因素、预后及预防措施。方法:对我院2000年3月～2009年12月3854例行冠状动脉介入治疗(PCI)中4例二次血栓形成病人的临床特征、冠状动脉造影及支架置入情况、预后及预防措施等进行回顾性分析。结果:3854例者行冠状动脉支架治疗,4例病人发生二次血栓形成(0.1%),均为急性冠脉综合征病人。其中,男女各2人,吸烟史2例,合并糖尿病3例,高脂血症3例,高血压2例。血栓相关血管累及前降支近段4例,累及右冠状动脉近段1例(1例患者为2个支架内均有血栓形成)。最终造影显示TIMI血流达3级3例。停用波立维1例,血小板聚集率明显增高1例。结论:二次血栓防治策略是积极控制危险因素、治疗原发病、充分的预扩张、血管内超声的应用、应用高压球囊使支架贴壁良好及合理的使用抗血小板药物。

Analysis on Causes of Repeated Stent Thrombosis

Objective:To analyze the risk factors,prognosis and prevention strategies of repeated stent thrombosis.Methods:We evaluated 3854 patients who received stent implantation from March 2000 to December 2009 in our hospital and retrospectively analyzed clinical characteristics,coronary angiography,stent implantation,prognosis and prevention strategies of repeated stent thrombosis in 4 patients.Results:Of 3854 patients with stent thrombosis,4 patients occurred repeated stent thrombosis(0.1%),they were all acute coronary syndrome.Of 4 casesjnale 2,female 2,smoking history 2,diabetes 3,hyperlipidemia 3,hypertension 2.Thrombosis lesions on left anterior descending artery(LAD) 4,right coronary artery 1(two stent thrombosis in 1 patient),angiography eventually showed TIMI flow 3 3.Stop taking clopidogrel 1,platelet aggregation was significantly higher in 1 case. Conclusions:Prevention strategies of repeated stent thrombosis.should be actively managing risk factors,treatment of the primary disease,adequate preexpansion, the application of intravascular ultrasound,applied high-pressure balloon stent adherent to good and rational use of anti-platelet drugs.