可生物降解涂层药物洗脱支架介入治疗的近期疗效

目的 评估国产新型西罗莫司可生物降解涂层支架在急性心肌梗死患者介入治疗(percutaneous coronary intervention,PCI)中的疗效及安全性.方法 急性心肌梗死患者56例,其中ST段抬高性心肌梗死48例,非ST段抬高性心肌梗死8例,均置人西罗莫司可生物降解涂层洗脱支架,观察手术成功率、支架内血栓等并发症及主要不良心脏事件(main adverse coronary events,MACE)发生率,术后随访1～14个月,6～9个月行冠状动脉造影复查.结果 成功行PCI 55例,手术即刻成功率98%.82处病变共置入西罗莫司支架98枚,其中17枚(17.3%)为直接支架术.4例出现无复流现象,1例使用主动脉气囊反搏.1例术后6 h猝死,考虑急性支架内血栓.术中及住院期间无其他严重并发症发生.50例(89.3%)随访1～14个月,无晚期支架内血栓发生,无MACE;复查冠状动脉造影19例,1例发生支架内再狭窄,无需血运重建.结论 国产西罗莫司可生物降解涂层支架在急性心肌梗死患者行PCI治疗有较好疗效及安全性.     

冠状动脉西罗莫司洗脱支架置入后晚期支架内血栓形成分析

目的分析冠状动脉药物洗脱支架置入后晚期支架内血栓形成的临床相关因素。方法回顾性分析2003年7月至2005年1月我院置入西罗莫司洗脱支架的1304例冠心病患者中发生晚期支架内血栓的8例患者的临床资料、冠状动脉病变特点、支架释放情况以及术后的抗血小板治疗等相关因素。结果8例患者平均年龄（51±10）岁、7例为急性冠状动脉综合征患者且伴有多项心血管病危险因素,仅1例患者伴有左室功能不全,无肾功能不全患者;多支冠状动脉病变患者6例且病变较复杂,包括闭塞、分叉、开口和弥漫长病变;支架释放压力平均（1175.37±167．19）kPa（11．60±1．65atm）,全部患者未用高压球囊进行后扩张;双重抗血小板治疗平均时间为（157．5±41．7）d,1例在停用氯吡格雷第7天、2例在服用阿司匹林和氯吡格雷治疗期间、5例停用氯吡格雷6个月后出现支架内血栓,平均血栓发生时间为术后（450．3±344．7）d,5例表现为急性心肌梗死;1例死亡,5例再次置入西罗莫司洗脱支架,术后随访无症状,1例药物治疗。结论发生晚期支架内血栓的冠心病患者多表现为急性冠状动脉综合征、伴有多项心血管病危险因素;多支、复杂冠状动脉病变;支架低压释放,置入后未行后扩张;双重抗血小板治疗时间短。发生晚期支架内血栓患者预后差,死亡率较高,再次置入西罗莫司洗脱支架是安全、有效的。     

国产西罗莫司洗脱支架与裸支架治疗急性心肌梗死临床疗效的比较

目的探讨国产西罗莫司洗脱支架与裸支架治疗急性心肌梗死（AMI）临床疗效的差异。方法173例连续行直接PCI的AMI患者随机分为西罗莫司洗脱支架组（87例）和裸支架组（86例）,分析住院期间和支架置入后6个月的支架内血栓、主要心血管事件（包括再次心肌梗死、缺血性靶血管重建和死亡）发生率及6个月再狭窄率。结果两组患者在术后血管通畅、肌酸激酶峰值、心功能和住院期间心脏事件方面差异均无统计学意义（P〉0．05）。两组各有2例支架内血栓（2．4％比2．3％,P〉0．05）。6个月时,国产西罗莫司洗脱支架组的支架内再狭窄率（4．5％比40．0％,P〈0．01）、节段内再狭窄率（6．8％比44．9％,P〈0．01）和主要不良心脏事件发生率（8．0％比24．4％,P〈0．01）显著低于裸支架组。国产西罗莫司洗脱支架组主要心脏事件的减少主要是因为缺血性靶血管重建减少所致（3．4％比11．6％,P〈0．05）。结论与裸支架相比,国产西罗莫司洗脱支架治疗AMI患者并未增加6个月内支架内血栓的发生,而显著降低6个月的再狭窄率和主要心脏事件发生率。     

药物洗脱支架置入术后晚期、极晚期支架内血栓形成的光学相干断层成像分析

目的:应用光学相关断层成像(OCT)分析药物洗脱支架置入术后晚期、极晚期支架内血栓形成的可能机制。方法:入选2011-01-2017-12经遵义医学院附属医院行冠状动脉(冠脉)造影明确诊断晚期、极晚期支架内血栓形成患者8例。8例患者在PCI术中均行OCT检查。回顾性分析8例患者的临床资料、PCI过程及OCT图像特征。结果:7例伴有多个心血管危险因素,2例合并轻度左心功能不全。首次支架置入至发生支架血栓的平均时间(818±651) d;双联抗血小板服用平均时间(312.8±76.3) d;低密度脂蛋白胆固醇(LDL-C)平均水平为(3.44±1.35) mmol/L,均未达到目标值;1例在术后停用双联抗血小板3个月、2例在服用双联抗血小板期间、5例在单用阿司匹林期间发生支架内血栓;6例置入依维莫司药物支架,1例行支架内非顺应性高压球囊扩张,1例行紫杉醇药物球囊治疗。OCT图像特征:7例患者支架内异质性新生内膜形成,5例为支架内新生动脉粥样硬化伴斑块破裂,2例为支架内新生动脉粥样硬化伴斑块侵蚀;1例出现严重支架贴壁不良,贴壁不良比例达66.2%;6例患者出现不同程度的支架小梁无内膜覆盖,平均为(10.4±6.2)%;5例支架内见红血栓,3例支架内见白血栓。结论:晚期、极晚期支架内血栓患者首次及再次住院多表现为急性冠脉综合征与高LDL-C水平。支架内新生动脉粥样硬化、支架贴壁不良是导致晚期、极晚期支架内血栓形成的主要原因之一。OCT的应用有助于明确晚期和极晚期支架内血栓形成的机制。     

国产西罗莫司洗脱支架与紫杉醇洗脱支架临床效果比较研究

目的比较国产西罗莫司洗脱支架(FBS)和进口紫杉醇洗脱支架(PES)治疗冠状动脉狭窄的效果。方法选择阜外心血管病医院2004年4月至2005年8月连续接受国产西罗莫司洗脱支架或紫杉醇洗脱支架治疗,并且进行冠状动脉造影随访的228例冠心病患者。排除支架置入失败、位置不理想者。所有的患者术后均接受阿司匹林300mg/d、氯吡格雷75mg/d等规范药物治疗。患者在支架术后6个月后接受冠状动脉造影随访。结果共228例患者(198名男性,30名女性)314个靶病变接受治疗并完成造影随访。其中C型病变占总数的40.1%,平均术前参考血管直径2.80±0.47mm。平均每个病变支架长度25.90±14.54mm。228例患者中118例置入紫杉醇洗脱支架,100例置入西罗莫司洗脱支架。两组在患者基本条件方面,国产西罗莫司洗脱支架组患者年龄大于紫杉醇洗脱支架组,紫杉醇洗脱支架组有更多的2型糖尿患者;在病变基本条件方面,国产西罗莫司洗脱支架组病变更多偏心性病变,其他没有差别。6个月后随访结果国产西罗莫司洗脱支架组的支架再狭窄率明显低于紫杉醇洗脱支架组(5.3%比21.9%,P<0.001)。国产西罗莫司洗脱支架组的靶病变血管重建率(TLR)明显低于紫杉醇洗脱支架组(3.8%比13.1%,P<0.001)。国产西罗莫司洗脱支架组支架内晚期腔径丢失明显小于紫杉醇洗脱支架组(0.18±0.41mm比0.58±0.69mm,P<0.001)。结论国产西罗莫司涂层支架用于临床实践有良好的疗效。     

急性心肌梗死介入治疗后冠状动脉支架内亚急性血栓分析

目的 探讨急性心肌梗死(AMI)支架置入术后支架内亚急性血栓形成的相关因素.方法 612例AMI支架置入术后患者,4例发生支架内亚急性血栓,分析血栓形成的相关因素.结果 4例AMI患者在介入治疗后2～13 d发生原梗死部位的再次AMI,经冠状动脉造影证实支架内血栓形成,发生率近0.7%,3例裸金属支架,1例药物洗脱支架.3例合并高血压,2例合并糖尿病.1例支架贴壁不完全,2例补救性PCI因出血并发症未规范抗凝、抗血小板治疗,再次PCI后,1例因左心衰死亡.结论 AMI后支架内亚急性血栓多发生于合并高血压、糖尿病患者,以及介入治疗后明显残余狭窄、血栓残留病变患者,合理选用支架,规范抗凝、抗血小板治疗是防止发生支架内亚急性血栓的关键措施.     

国产西罗莫司药物洗脱支架治疗冠心病331例的疗效及安全性

目的探讨国产西罗莫司药物洗脱支架治疗冠心病的安全性与有效性。方法对331例冠心病患者采用经股动脉途径冠状动脉造影及常规方法行国产药物洗脱支架置入术,记录住院期间主要不良心脏事件(MACE)发生情况,术后1年随访,6~9个月行冠状动脉造影复查。结果331例冠心病患者共置入支架597只,均成功置入病变处;1例心源性休克行急诊经皮冠状动脉介入治疗(PC I)支架置入后3 h死于泵衰竭,1例发生血管破裂转外科行急诊冠状动脉旁路移植术,3例术后出现非Q波型心肌梗死,住院期间MACE发生率为1.5%。301例患者随访12.3±3.2个月,2例死亡,2例支架内血栓形成,1例非致死性心肌梗死,16例再次心绞痛发作,5例再次靶病变血运重建术,总的MACE发生率为4.3%;110例患者6~9个月行冠状动脉造影复查,6例支架内再狭窄,再狭窄率5.5%。结论国产西罗莫司药物洗脱支架治疗冠心病患者安全、有效,有较好的近、中期疗效和较高的效益/价格比,尤其适用于经济欠发达地区,可使更多冠心病患者受益;但其远期效果有待进一步研究。     

药物洗脱支架术后极晚期血栓形成原因及防治进展

药物洗脱支架能有效减少支架再狭窄率和靶血管的再次血运重建,但与金属裸支架相比,药物洗脱支架极晚期血栓（VLST）发生率呈上升趋势。研究显示药物洗脱支架术后再内皮化延迟、抗血小板药物抵抗、PCI操作技术与晚期血栓形成有密切相关。本文就 VLST形成原因、危险因素及防治策略作以下综述。     

西罗莫司洗脱支架和金属裸支架治疗冠心病的远期安全比较研究

目的比较西罗莫司药物洗脱支架和金属裸支架治疗冠心病患者的远期安全性。方法选择北京安贞医院2000年1月至2004年8月置入金属裸支架的冠心病患者505例,与2004年1月至2005年1月置入西罗莫司洗脱支架的984例冠心病患者进行历史性对照分析,比较两组患者支架术后随访2年的死亡、支架内血栓、非致死性心肌梗死发生率。结果两组患者在合并吸烟、高血压、高血脂、糖尿病所占比例及冠状动脉病变支数方面差异均无统计学意义。西罗莫司洗脱支架组患者平均年龄较大、分叉病变比例高、置入支架平均直径小且平均支架长度较长。临床随访2年,两组患者生存率、支架内血栓、非致死性心肌梗死及死亡/非致死性心肌梗死发生率方面差异均无统计学意义(分别为99.3%、1.3%、1.1%、1.8%和98.3%、1.7%、1.7%、3.5%,P0.05)。结论西罗莫司洗脱支架和金属裸支架在冠心病患者中应用的远期安全性相似。     

药物洗脱支架植入术后血栓形成15例的临床观察

目的探讨药物洗脱支架植入术后血栓形成患者的临床特点和治疗方法。方法回顾性分析15例PCI治疗后发生ST的冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料,着重分析发生ST的临床特征、治疗方法及结果。结果药物洗脱支架植入术后发生急性ST5例,亚急性ST7例,晚期ST2例,迟发晚期ST1例。15例均有典型胸痛表现,13例心电图检查示缺血性改变及酶学增加,12例行冠状动脉造影证实发生ST。其中合并原发性高血压13例,高血脂11例,吸烟10例,糖尿病10例,肾功能衰竭5例,心力衰竭6例。15例患者有2例随访过程院外发生心源性猝死,13例心电图证实支架段血管支配区域心肌缺血加重或呈急性心肌梗死表现,1例使用主动脉内气囊反博支持3d后死亡。剩余12例心导管造影复查示支架内闭塞,7例紧急PCI治疗行球囊扩张后血栓消失,均为亚急性ST;2例急诊行冠状动脉血栓抽吸术并冠状动脉内使用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂,均为急性ST。3例再次支架植入后血管再通,均为晚期及迟发晚期ST。12例经再次介入治疗均成功。结论药物洗脱支架植入术后ST的发生与患者高龄、糖尿病、过早停用抗血小板药物、心功能不全、多支病变、前降支病变等有关,再次PCI治疗为首选治疗方法。     

Very late thrombosis after implantation of sirolimus eluting stent

Stent thrombosis after sirolimus eluting stent implantation has been reported to occur at six hours to 375 days after the procedure and usually within the two weeks after discontinuation of antiplatelet medication. A case is reported of very late stent thrombosis after 17 months of sirolimus eluting stent implantation and eight months after clopidogrel discontinuation despite aspirin continuation. This case underlines the possible need for long term antiplatelet medication among patients receiving sirolimus eluting stents.     

OCT对于DES术后晚期或晚晚期血栓治疗的指导作用

目的 观察光学相干断层成像（OCT）技术对于药物洗脱支架（DES）术后发生晚期或晚晚期血栓治疗对策的指导作用.方法 选取2010年7月至2013年11月本院收治的行DES支架置入术后发生晚期或晚晚期支架内血栓患者22例,对患者行OCT检查,根据OCT结果采取进一步治疗措施.结果 DES术后晚期或晚晚期血栓的OCT表现为：支架内皮化不全6例、贴壁不良12例、支架内新生动脉粥样硬化斑块形成8例,支架内纤维过度增生较为少见2例,有些患者上述情况同时存在.治疗对策：单纯支架内皮化不全及支架贴壁不良者采取单纯球囊扩张术12例,新生动脉粥样硬化斑块形成或纤维过度增生者采取球囊扩张加支架置入术10例.结论 OCT可以准确了解DES术后晚期或晚晚期血栓的原因,提供更为合适的治疗方案.     

药物涂层支架内血栓形成特点分析

目的 探讨冠状动脉造影证实的药物涂层支架(DES)内血栓形成患者的临床特点.方法 回顾性收集我中心2005年3月至2009年3月冠状动脉造影证实的支架内血栓形成患者的临床情况、造影结果、经皮冠状动脉介入治疗(PCI)过程、抗血小板治疗等资料,分析支架内血栓形成特点和治疗及预后情况.结果 20例冠状动脉造影证实的支架血栓形成患者,发生率为 1.03%(20/1946),均表现为ST段抬高性心肌梗死(STEMI),所有患者均为DES[其中18例(90.0%)为西罗莫司及其衍生物涂层支架(SES),2例(10.0%)为紫杉醇涂层支架(PES)].10例(50.0%)为亚急性支架血栓形成,1例(5.0%)为晚期支架血栓形成,9例(45.0%)为极晚期ST;3例(15.0%)再次发生支架血栓形成,1例(5.0%)2支血管同时发生支架血栓形成.所有患者均接受正规的氯吡格雷+阿司匹林抗血小板治疗1年,9例(45.0%)极晚期支架血栓形成均在停用氯吡格雷后发生.12例(60.0%)患者为长支架(支架长度≥30 mm)置入,其中8例(40.0%)患者为串联支架置入;10例(50.0%)亚急性支架血栓形成患者再次PCI时均接受球囊扩张,1例(5.0%)晚期支架血栓形成患者也接受球囊扩张,9例(45.0%)极晚期支架血栓形成患者再次PCI时,5例(25.0%)患者只接受球囊扩张;随访结果显示,2例(10.0%)患者院内死亡,1例(5.0%)患者因反复支架内血栓形成而接受冠状动脉旁路移植术.结论 支架内血栓形成少见,支架内血栓形成常导致STEMI;支架血栓形成与长支架置入和急诊PCI治疗有关;多数支架内血栓形成可通过球囊扩张治疗;某些患者存在多支血管同时、多次发生支架血栓形成的风险.

Abstract：

Objective To analyze the clinical characteristics and outcomes of angiographically confirmed drug-eluting stent thrombosis (ST). Methods All the angiographically confirmed ST was enrolled in the study from March 2005 to March 2009. Clinical data, angiographic outcomes, procedures of PCI, and anti-platelet treatment of ST were retrospectively collected. Results Total 20 cases of ST included 18 cases (90.0%) of sirolimus and derives eluting stents and 2 cases (10.0%) of paclitaxel eluting stent. Ten (50.0%) stent thromboses were subacute, 1 (5.0%) were late, and 9 (45.0%) were very late. ST reoccurred in 3 cases and occurred simultaneously in two arteries in 1 case. All the cases presented with ST-segment elevation myocardial infarction (STEMI). ST occurred in 16 cases after emergency PCI and 4 cases after selective PCI. Nine late stent thrombosis occurred after clopidogrel cessation. Long stents (stent length ≥ 30 mm) were implanted in 12 cases (60.0%), of which overlap stents were implanted in 8 cases (40.0%).Balloon angioplasty was used in 16 cases (80.0%). The 2 patients died from STEMI during hospitalization and 1 patient accepted coronary artery bypass graft for repetitive ST. Conclusions Angiographically confirmed ST appears rarely, but most frequent ST presents with STEMI. ST is related with long stent implantation and emergency PCI. Balloon angioplasty is frequently used for ST. Some patients have the risk of multiple arteries and repetitive ST.     

Very late stent thrombosis due to DES fracture: Description of a case and review of potential causes

Stent fracture and subsequent stent thrombosis are known complications after stent implantation, especially in stents with closed cell design like the first generation sirolimus drug eluting stents (DES). Late stent thrombosis is very rarely encountered in our patient population, majority Chinese. We report a case of non‐ST elevation myocardial infarction as a result of very late stent thrombosis (three years after implantation) due to stent fracture at the site of overlap of two first generation sirolimus DES. There were initial difficulties in restoring coronary flow by conventional reperfusion therapies but a successful outcome after implantation of an endothelial progenitor cell capture stent, with no further recurrence of ischemic event after 12 months. An attempt was made to analyze all existing factors present and contributing to the stent fracture and stent thrombosis in this case, as reported in the literature. © 2011 Wiley Periodicals, Inc.     

Stent fracture associated with drug‐eluting stents: Clinical characteristics and implications

Objective : To evaluate the clinical characteristics and implications of stent fracture in drug‐eluting stents. Background : Approximately 2.5 million drug‐eluting stents are implanted every year worldwide. In 10 randomized controlled trials involving 2,602 patients, no incidence of stent fracture was recognized or reported. Methods : From April 2003 to December 2005, 2,728 patients underwent drug‐eluting stenting. The angiograms of all 530 patients who underwent repeat angiography were analyzed to identify the presence of stent fracture. We then documented the incidence of adverse events associated with drug‐eluting stent fracture and systematically analyzed the clinical, procedural, and structural factors, which might predispose to stent fracture. Results : Stent fracture was identified in 10 patients. None of these fractures were detectable at the time of stent placement. The median time interval from stent implantation to detection of fracture at repeat angiography was 226 days (range, 7–620 days). Adverse clinical outcomes associated with stent fracture occurred in 7 patients (6 patients had binary restenosis and 1 patient had stent thrombosis), all necessitating repeat intervention. Analysis of potential predisposing clinical, procedural, and structural factors revealed that 4 patients had excessive tortuosity in the proximal segment, and overlapping stents were used in 5 cases. All fractures occurred in sirolimus‐eluting stents. Conclusions : Stent fracture may represent a new potential mechanism of restenosis and stent thrombosis in drug‐eluting stents. Predisposing clinical and procedural factors may be vessel tortuosity and use of overlapping stents. The most important predisposing factor, however, may be stent structure, since all fractures occurred in sirolimus‐eluting stents. © 2006 Wiley‐Liss, Inc.     

Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy

Although the safety profiles of coronary stents eluting sirolimus or paclitaxel do not seem to differ from those of bare metal stents in the short-to-medium term, concern has arisen about the potential for late stent thromboses related to delayed endothelialisation of the stent struts. We report four cases of angiographically-confirmed stent thrombosis that occurred late after elective implantation of polymer-based paxlitaxel-eluting (343 and 442 days) or sirolimus-eluting (335 and 375 days) stents, and resulted in myocardial infarction. All cases arose soon after antiplatelet therapy was interrupted. If confirmed in systematic long-term follow-up studies, our findings have potentially serious clinical implications.     

Eosinophilic responses to stent implantation and the risk of Kounis hypersensitivity associated coronary syndrome

The use of drug eluting stents constitutes a major breakthrough in current interventional cardiology because it is more than halves the need of repeat interventions. It is incontrovertible that coronary stents, in general, have been beneficial for the vast majority of patients. A small increase in thrombosis, following DES implantation, is offset by a diminished risk of complications associated with repeat vascularization. However, late and, especially, very late stent thrombosis is a much feared complication because it is associated with myocardial infarction with increased mortality. Despite that stent thrombosis is thought to be multifactorial, so far clinical reports and reported pathology findings in patients died from coronary stent thrombosis as well as animal studies and experiments, point toward a hypersensitivity inflammation. The stented and thrombotic areas are infiltrated by interacting, via bidirectional stimuli inflammatory cells including eosinophils, macrophages, T-cells and mast cells. Stented regions constitute an ideal surrounding for endothelial damage and dysfunction, together with hemorheologic changes and turbulence as well as platelet dysfunction, coagulation and fibrinolytic disturbances. Drug eluting stent components include the metal strut which contains nickel, chromium, manganese, titanium, molybdenum, the polymer coating and the impregnated drugs which for the first generation stents are: the antimicrotubule antineoplastic agent paclitaxel and the anti-inflammatory, immunosuppressive and antiproliferative agent sirolimus. The newer stents which are called cobalt-chromiun stents and elute the sirolimus analogs everolimus and zotarolimus both contain nickel and other metals. All these components constitute an antigenic complex inside the coronary arteries which apply chronic, continuous, repetitive and persistent inflammatory action capable to induced Kounis syndrome and stent thrombosis. Allergic inflammation goes through three phases, the early phase, the late phase and the chronic phase and these three phases correspond temporally with early (acute and sub acute), late and very late stent thrombosis. Bioabsorbable allergy free poly lactic acid self expanding stents, nickel free stainless steel materials, stent coverage with nitric oxide donors and antibodies with endothelial progenitor cell capturing abilities as well as stents eluting anti-inflammatory and anti-allergic agents might be the solution of this so feared and devastating stent complication.     

Late acute thrombosis after implantation of sirolimus‐eluting stent to treat in‐stent restenosis

Drug‐eluting stents (DES) have significantly reduced the incidence of in‐stent restenosis (ISR) compared to bare metal stents (BMS). However, recent randomized trials comparing DES with BMS reported few cases of late DES thrombosis. We report the case of late sirolimus‐eluting stent thrombosis occurring 22 months after its elective implantation in a restenotic BMS and soon after the interruption of combined anti‐platelet therapy with aspirin and Clopidogrel.     

Simultaneous Very Late Stent Thrombosis in Multiple Coronary Arteries

We report 2 noteworthy cases of very late stent thrombosis presenting as ST-segment-elevation myocardial infarction, with vastly different manifestations. Both patients were women who had histories of multivessel percutaneous coronary intervention with first-generation sirolimus-eluting stents, in 2005 and 2006. On the more recent occasions reported here, one underwent successful multivessel primary percutaneous coronary intervention, while the other underwent successful multivessel “plain old balloon angioplasty.” Both were discharged from the hospital with advice to stop smoking and to follow a lifelong regimen of aspirin and clopidogrel.On the basis of these two cases and our review of the current literature, we ask whether it is now prudent to recommend lifelong dual antiplatelet therapy after drug-eluting stent deployment. Moreover, in order to account for cases of stent thrombosis that occur ≥5 years after drug-eluting stent implantation, should we perhaps suggest the addition of “extremely late stent thrombosis” to the existing Academic Research Consortium classification?Key words: Aspirin, clopidogrel, coronary restenosis/etiology, coronary thrombosis/etiology, drug delivery systems/adverse effects, immunosuppressive agents, paclitaxel, platelet aggregation inhibitors/therapeutic use, sirolimus/therapeutic use, stent thrombosis, stents, drug-eluting/adverse effects, ST-elevation myocardial infarction, very late stent thrombosisStent thrombosis after percutaneous coronary intervention (PCI) remains a serious concern for both cardiologists and patients. The incidence of stent thrombosis within the first 30 days in patients randomized to receive sirolimus-eluting stents (SES) in clinical trials is reported to be no different from that in patients randomized to a control group receiving bare-metal stents.¹ Stent thrombosis has been reported as late as 17 months,² and more recently as late as 26 months, after SES implantation.³ We report 2 cases of simultaneous very late stent thrombosis in multiple coronary arteries ≥5 years after drug-eluting stent (DES) implantation, presenting as an ST-segment-elevation myocardial infarction (STEMI) despite a regimen of aspirin in patient 1 and both aspirin and clopidogrel in patient 2.     

急性冠脉综合征患者药物洗脱支架雷帕霉素CypherTM植入后的不良反应分析

目的:分析雷帕霉素药物洗脱支架CypherTM植入后对急性冠脉综合征患者近、远期的不良反应.方法: 选择接受CypherTM治疗的冠心病患者83例,在支架植入术后9个月内全部接受门诊随访及冠脉造影,了解支架内急性和亚急性血栓、边缘效应、贴壁不良现象、支架处动脉瘤发生率及相应的不良心脏事件(MACE)发生情况.结果:83例患者共植入支架112个,植入成功率为98.8%(82/83).29例(34.9%)接受冠脉造影,MACE9例,发生率10.8%(9/83),其中,1例术中发生猝死,1例术后3d因亚急性血栓造成再发心肌梗死,其余7例在出院后1～3 月内发生心绞痛,皆经造影证实为血栓形成,再次成功靶血管血运重建8例;其余20例无症状患者造影发现支架边缘狭窄(无血栓)2例,总再狭窄为13.3%(11/83);无动脉瘤发生.9例MACE中,有弥漫病变5例,其中4例植入长支架,1例植入重叠支架,其余为简单病变;29例患者共发现贴壁不良现象5例,皆发生MACE,其中4例为弥漫病变植入长支架,1例为简单病变.结论:急性或亚急性血栓形成是药物支架CypheTM植入后出现的主要不良反应,可能与弥漫病变植入长、重叠支架引起贴壁不良有关.