冠状动脉支架术后支架内亚急性血栓形成(附5例报告)

目的评价和探讨支架内亚急性血栓（SAT）的发生机制和预防。方法随访和分析2004-2007年5例冠心病患者支架置入术后发生SAT患者的临床和冠脉造影特点。结果（1）在529例冠心病支架置入患者中有5例（0.94%）发生SAT,多于术后2～5d出现。其中3例冠脉造影证实SAT,积极治疗后6个月冠脉造影随访支架内无再狭窄;2例可能为SAT;死亡2例,1例在院外死亡,均为未及时介入治疗。（2）上述5例患者中3例表现为ST抬高型心肌梗死,1例表现为急性左心衰,心源性休克,1例表现为不稳定性心绞痛。4例患者为药物洗脱支架后SAT,1例为裸支架后SAT。结论支架内SAT可能与C型病变,术中支架贴壁不良,急性心肌梗死有关,及时介入治疗可以减少不良后果的发生。     

雷帕霉素洗脱支架治疗冠脉左前降支近中段病变的临床疗效评价

目的评价雷帕霉素洗脱支架治疗冠脉左前降支近中段病变的临床疗效。方法以冠脉造影显示左前降支近中段狭窄病变并分别置入雷帕霉素洗脱支架(SES组)或裸金属支架(BMS组)的患者各100例为研究对象。记录患者的一般情况、临床和冠脉病变特征,术后1年临床随访和冠脉造影复查。结果两组患者匹配良好,仅SES组置入支架的长度显著长于BMS组(21.07±7.45mmvs18.25±6.82mm,P=0.0057)。在随访中,无心源性死亡,SES组1例因支架内再狭窄发生急性心肌梗死。冠脉造影复查显示SES组再狭窄率较BMS组显著降低(7.4%vs25.9%,P=0.002),并直接导致不良事件发生率的下降。结论药物洗脱支架显著降低左前降支近中段狭窄病变介入治疗后再狭窄发生率,可作为血运重建的一种有效策略。     

药物洗脱支架置入后血栓形成的原因分析

目的探讨药物洗脱支架置入后血栓形成的发生率以及血栓形成的原因。方法本研究为单中心药物洗脱支架的注册研究,自2001年12月至2005年12月共计3345例冠心病患者接受了药物洗脱支架的治疗,其中使用雷帕霉素洗脱支架（SES）2165例,使用紫杉醇洗脱支架（PES）1180例,完成10个月临床随访为2296例;所有患者均同时口服阿司匹林和氯吡格雷至少9个月。结果3345例患者中9例发生急性血栓形成（O．27％）,其中7例为SES、2例为PES所致（0．32％比0．17％,P=0．637）;7例发生亚急性血栓形成（0．21％）,其中5例为SES、2例为PES所致（0．23％比0．17％,P=0．526）;急性和亚急性血栓发生率为0．48％（16／3345）;13例有晚期血栓形成,5例为SES、8例为PES所致（0．34％比0．95％,P=0．114）;4例晚期血栓形成的主要原因为提前中断抗血小板药物,既往患有心肌梗死病史,心功能差,药物洗脱支架置入后晚期发生血栓致猝死6例。结论支架置入不满意,特别是分叉病变以及支架未能完全覆盖受损伤的病变段是急性和亚急性血栓形成的主要原因;中断抗血小板药物和左心功能不全是晚期血栓形成的主要原因。     

冠状动脉支架内血栓形式的诊治体会

目的探讨冠状动脉支架内血栓形成的原因和处理方法。方法回顾性分析我院自开展冠脉介入手术以来9例支架内血栓形成患者的临床资料、冠状造影特点及其处理措施。结果 11年间共有3162例患者行冠脉介入治疗,共发生冠脉支架内急性、亚急性血栓7例,发生率0.22%,晚期血栓1例,发生率0.03%,极晚期血栓1例,发生率0.03%。结论冠状动脉支架内血栓形成与冠脉血管病变长、支架贴壁不良、钙化病变、支架未完全覆盖病变、支架膨胀不全、介入操作及围术期抗凝,抗血小板治疗不充分等因素有关,急诊PTCA、血栓抽吸导管抽吸血栓、强化抗血小血板是治疗冠脉支架内血栓形成的主要措施。     

药物洗脱支架术后血栓致急性冠状动脉综合征病因分析及处理评价

目的:分析药物洗脱支架术(DES)后支架内血栓形成导致急性冠状动脉综合征的影响因素。方法:分析38例DES术后形成支架内血栓形成患者的临床特点、冠状动脉病变特点、手术相关资料及患者发生急性冠状动脉综合征后的临床表现,处理措施和预后情况。结果:患者冠状动脉造影显示病变特点比较复杂,其中B2/C型病变占到了71%,分叉病变、慢性完全闭塞(CTO)病变、弥散长病变以及小血管病变也占到了相当大的比例,反映了真实的临床情况;38例患者中52.6%表现为急性ST段抬高心肌梗死,29%的患者表现为急性非ST段抬高心肌梗死;支架内血栓中急性、亚急性血栓形成占63%,晚期及迟发晚期血栓形成占37%;绝大多数患者成功接受了再次血运重建治疗,其中有31.6%的患者死亡;2例患者血小板聚集率≥50%,发生率为8.3%;4例接受冠脉内超声(IVUS)检查的患者结果显示:支架近端贴壁不良1例,支架远端残余夹层1例,支架内膜增生不完全1例,支架两端动脉瘤形成1例。结论:DES术后支架内血栓形成与患者的冠状动脉病变复杂程度、术后抗血小板治疗不充分、支架贴壁不良、夹层形成、内膜增生不完全以及动脉瘤的发生等因素相关,支架内血栓形成(ST)后多数表现为ST段抬高心肌梗死(STEMI),尽管大部分能成功再次血运重建治疗,但死亡率仍然较高(31.6%)。     

冠状动脉支架内血栓形成

冠状动脉内支架是致血栓物质,主要是因为支架金属表面的阳离子电荷作用.支架的材料、形状、大小都会影响支架血栓的形成.根据支架内血栓发生的时间分为三类.(1)急性支架内血栓:24 h内进行冠状动脉造影显示支架部位血栓.(2)亚急性支架内血栓:1～30天进行冠状动脉造影见支架部位血栓形成.(3)后期支架内血栓形成:其定义为支架置入30天以上发生在支架置入部位急性血栓形成[1].     

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.     

雷帕霉素洗脱支架冠状动脉造影随访结果分析

目的通过对接受雷帕霉素洗脱支架(sirolimus-eluting stent,SES)治疗的冠心病患者冠状动脉造影随访,观察其临床实际应用的效果。方法339例患者接受治疗,所有患者均接受了临床随访,165例患者于置入术后6~12个月行冠状动脉造影复查。结果冠状动脉造影随访时,支架近端边缘晚期管腔丢失显著高于支架内及支架远端边缘(0.17 mmvs0.08 mmvs0.09 mm),再狭窄率为9.7%,再血管化率4.84%,再狭窄以局限性狭窄为主。在339例患者中,有4例患者于支架置入后5天~4个月发生猝死。猝死发生率为1.18%。1例于支架置入后14天发生支架内亚急性血栓形成,发生率0.50%。晚期血栓形成1例(术后12个月),主要心血管不良事件为1.70%。结论对复杂的冠状动脉病变SES有较好的疗效,能显著降低支架后再狭窄,减少靶血管的再血管化率。     

T支架技术治疗分叉病变的临床效果研究

目的:评价T支架技术治疗分叉病变的临床效果。方法:回顾性分析从2004年4月到2006年1月我院对分叉病变连续行T支架技术47例患者临床情况。结果:患者基线特点:年龄(59.2±10.8)岁;性别:男性89.4%;既往心肌梗死27.7%;既往经皮冠状动脉介入治疗(PCI)19.1%;糖尿病23.4%;左心室射血分数0.48±0.34。病变基线特点:病变位置:左主干分叉42.6%、前降支和对角支53.2%、回旋支和钝缘支4.3%;主支参照血管直径(3.43±0.51)mm;边支参照血管直径(2.85±0.19)mm;主支病变长度(17.6±10.6)mm;边支病变长度(13.2±7.6)mm。经股动脉入径59.6%;置入药物洗脱支架56.4%;主支支架释放压力(14.5±2.8)atm(1 atm=101.325 kPa);边支支架释放压力(12.3±2.5)atm;对吻球囊技术(kissing balloon) 89.4%。支架置入成功率100%。主要心脏不良事件(MACE)6例(13%);死亡1例(2.1%),因支架内亚急性血栓形成;急性心肌梗死2例(4.3%),造影证实为支架内亚急性血栓形成,行急诊PCI治疗;靶病变再次血管成形术5例(10.6%),其中2例因支架亚急性血栓、2例因再狭窄行再介入治疗,1例因再狭窄行冠状动脉旁路移植术。6个月临床随访91.5%,造影随访29.8%,再狭窄率21.4%。结论:T支架技术治疗分叉病变操作成功率很高,但具有一定风险。     

肝素膜支架的临床应用

目的　评价肝素膜支架对预防急性 亚急性支架内血栓形成的有效性。方法　对 2 8例病人的 32个靶病变置入肝素膜支架 ,其中单支病变 2 4例 ,双支病变 4例 ,LAD病变 19个 ,RCA病变10个 ,LCX病变 3个。手术成功率 10 0 % ,术后随访 6～ 2 4个月无急性 亚急性血栓形成 ,5例心绞痛复发 ,3例经造影证实再狭窄 ,无死亡病例。结论　肝素膜支架对于预防急性 亚急性支架内血栓形成是有一定的疗效     

Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation

OBJECTIVES: We sought to determine the real-world incidence of angiographically confirmed and possible stent thrombosis (ST) in an unrestricted population during the first 30 days after bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES) implantation. BACKGROUND: Current data on ST in drug-eluting stents (DES) have come from randomized trials with strict entry criteria, which limits their generalizability to daily practice. METHODS: The study population comprised three sequential cohorts of 506 consecutive patients with BMS, 1,017 consecutive patients with SES, and 989 consecutive patients treated with PES. RESULTS: In the first 30 days after stent implantation, 6 BMS (1.2%, 95% confidence interval [CI] 0.5% to 2.6%; p = 0.9), 10 SES (1.0%, 95% CI 0.5% to 1.8%), and 10 PES (1.0%, 95% CI 0.6% to 1.9%) patients developed angiographically proven ST. Multiple potential risk factors were identified in most patients with ST. Bifurcation stenting in the setting of acute myocardial infarction was an independent risk factor for angiographic ST in the entire population (odds ratio [OR] 12.9, 95% CI 4.7 to 35.8, p < 0.001). In patients with DES who had angiographic ST, 30-day mortality was 15%, whereas another 60% suffered a nonfatal myocardial infarction; no further deaths occurred during six months of follow-up. Including possible cases, 7 BMS (1.4%, 95% CI 0.7% to 2.8%), 15 SES (1.5%, 95% CI 0.9% to 2.4%), and 16 PES (1.6%, 95% CI 1.0% to 2.6%) patients had ST. CONCLUSIONS: The unrestricted use of SES or PES is associated with ST rates in the range expected for BMS. Stent thrombosis was associated with a high morbidity and mortality. Bifurcation stenting, when performed in patients with acute myocardial infarction, was associated with an increased risk of ST.     

西罗莫司洗脱支架置入术后血栓发生率及相关因素分析

目的观察西罗莫司洗脱支架冠状动脉内置人术后,支架血栓发生率及临床相关因素。方法2006年4月至2007年8月间,156例患者于首都医科大学大兴医院置入西罗莫司洗脱支架（Cypher select和Firebird支架）,84例患者随防1年,72例患者随访半年,明确支架血栓发生情况;分析支架血栓的相关因素及转归。结果早期支架血栓3例（1．92％）,晚期支架血栓1例（0．64％）。4例支架血栓患者多支病变（〉2支）2例,分叉病变2例,弥漫长病变2例。共置入支架6枚,平均1．5枚／人,平均支架直径（2．88±0．38）mm,平均长度（25．5±6．12）mm,支架释放压力（13．33±1．03）atm,一枚支架置入后行后扩张,术后TIMI血流均为3级。1例术后3d出现介入血管急性ST段抬高心肌梗死,爱通立溶栓后再通并出现休克,置入主动脉气囊反搏治疗5d,现病情平稳;2例分别于术后6d及15d猝死;1例于术后81d猝死。结论156例西罗莫司洗脱支架置入后,早期支架血栓3例,晚期支架血栓1例;表现为急性心肌梗死或猝死;多数患者为急性冠状动脉综合征,多支病变、分叉病变、弥漫长病变,因无血管内超声指导可能遗留残余夹层或支架贴壁不全;发生支架血栓患者预后差,死亡率高。     

Very late stent thrombosis after sirolimus-eluting stent implantation observed using optical coherence tomography and coronary angioscopy

Sirolimus-eluting stents (SES) are now commonly used for percutaneous coronary intervention (PCI) because they dramatically reduce the rates of restenosis and target lesion revascularization, even in small vessels and long lesions as compared with bare-metal stent. The unresolved issue about SES use is the possibility of late stent thrombosis. Late stent thrombosis is a very rare, but serious complication that may result in acute myocardial infarction or sudden cardiac death. However, the mechanism of late stent thrombosis with SES has not been established. We report a patient with very late stent thrombosis 37 months after SES implantation who underwent optical coherence tomography and coronary angioscopy.     

Stent thrombosis after sirolimus- and paclitaxel-eluting stent implantation in daily clinical practice: analysis of a single center registry.

OBJECTIVES: To evaluate stent thrombosis (ST) rate after sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation in daily clinical practice. BACKGROUND: The safety profile of drug-eluting stents (DES) was predominantly determined in randomized clinical trials with narrow inclusion criteria. Concerns about ST have been raised in unselected patients treated with DES. METHODS: We prospectively evaluated 867 patients undergoing DES implantation, 618 patients with SES, and 249 with PES, in a single academic center. RESULTS: Multivessel disease was present in 72% of patients, multivessel stenting was performed in 17%, long (>18 mm) lesions were treated in 30%, and multiple stents per lesion were needed in 31%. On average, 1.7 +/- 0.8 stents per patient were implanted (stented segment length: 32 +/- 25 mm/vessel). IIb/IIIa inhibitors were used in 7.5%. Intravascular ultrasound (IVUS) guidance was employed in 65% of SES and 50% of PES implantations, and the procedural success rate was 100% in SES and 99% in PES cases. Six-month follow-up was performed in all patients, whereas one-year follow-up was completed in 87% patients of the SES group and in 95% of the PES group. We considered that ST occurred when angiographic evidence of thrombus was available, or when patients experienced sudden cardiac death or either ST-elevation or non-ST-elevation myocardial infarction (MI) through the 12-month follow-up period. The overall incidence of ST was 0.9% (0.4% in SES and 2% in PES, P = 0.03). Of the eight ST, two (25%) were acute, four (50%) subacute, one (12.5%) was a late event, and one (12.5%) a very late event. Seven ST were confirmed by angiography. No IVUS guidance was used in 4/8 (50%) ST patients, while antiplatelet therapy was prematurely discontinued in 3/8 (37.5%). Among ST patients, mortality and nonfatal MI rates were 25% and 37.5%, respectively. No ST was diagnosed between 6 and 12 months, while one very late thrombosis occurred at 15 months. CONCLUSIONS: The incidence of ST after DES use in daily clinical practice is low and similar to that observed in randomized clinical trials.     

Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation

OBJECTIVES: This study was designed to compare the clinical and angiographic outcomes of sirolimus-eluting stent (SES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) stenosis. BACKGROUND: The safety and effectiveness of SES implantation for unprotected LMCA stenosis have not been ascertained. METHODS: Elective SES implantation for de novo unprotected LMCA stenosis was performed in 102 consecutive patients with preserved left ventricular function from March 2003 to March 2004. Data from this group were compared to those from 121 patients treated with BMS during the preceding two years. RESULTS: Compared to the BMS group, the SES group received more direct stenting, had fewer debulking atherectomies, had a greater number of stents, had more segments stented, and underwent more bifurcation stenting. The procedural success rate was 100% for both groups. There were no incidents of death, stent thrombosis, Q-wave myocardial infarction (MI), or emergent bypass surgery during hospitalization in either group. Despite less acute gain (2.06 +/- 0.56 mm vs. 2.73 +/- 0.73 mm, p < 0.001) in the SES group, SES patients showed a lower late lumen loss (0.05 +/- 0.57 mm vs. 1.27 +/- 0.90 mm, p < 0.001) and a lower six-month angiographic restenosis rate (7.0% vs. 30.3%, p < 0.001) versus the BMS group. At 12 months, the rate of freedom from death, MI, and target lesion revascularization was 98.0 +/- 1.4% in the SES group and 81.4 +/- 3.7% in the BMS group (p = 0.0003). CONCLUSIONS: Sirolimus-eluting stent implantation for unprotected LMCA stenosis appears safe with regard to acute and midterm complications and is more effective in preventing restenosis compared to BMS implantation.     

Treatment of multivessel coronary artery disease with sirolimus-eluting stent implantation: immediate and mid-term results

OBJECTIVES: This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions. BACKGROUND: Safety and effectiveness of multivessel SES implantation is currently unknown. METHODS: Major adverse cardiac events (MACE) (death, myocardial infarction [MI], and repeat revascularization) were analyzed at 30 days and at 6 months after multivessel SES implantation. RESULTS: In 155 consecutive patients, 573 SES were implanted in 3.3 +/- 1.3 lesions per patient. At 30 days, the cumulative MACE rate was 10.3%: 7.1% patients developed a non-Q-wave MI, 1.9% developed a Q-wave MI, 0.6% died for non-cardiac reasons, and 0.6% had a repeat revascularization. Clinical follow-up was obtained in all 112 eligible patients treated for 359 lesions at a mean time of 6.5 +/- 2.2 months. The cumulative MACE rate was 22.3%: 3 (2.7%) deaths (1 for cardiac reasons), 4 (3.6%) MIs, target lesion revascularization (TLR) in 16 (14.3%) patients with 24 (6.7%) lesions. Target vessel revascularization was required in 18 (16.1%) patients due to TLR of lesions treated with SES or to disease progression (1.8% of patients). Cox regression analysis revealed total stent length per patient as the most powerful independent predictor of MACE. Overall stent thrombosis occurred in three (1.9%) patients. CONCLUSIONS: Multivessel SES implantation can be safely performed on patients with complex coronary artery disease. The need for revascularization increases because of the cumulative effect of TLR on patients with multiple lesions.     

Late coronary stent thrombosis: early vs. late stent thrombosis in the stent era.

The incidence of coronary stent thrombosis is < 1%-2% in recent studies, with the highest-risk period considered to be the first 30 days following stent implantation. Recently, stent thrombosis after 30 days has been reported in patients undergoing brachytherapy with stenting. We reviewed the incidence of stent thrombosis causing myocardial infarction in nonbrachytherapy patients at our institution between 1 January 1996 and 30 November 1999. A case control methodology was employed with a 1:3 ratio of stent thrombosis to control patients. Of 1,191 patients undergoing coronary stenting, acute (< 24 hr) plus subacute (1-30 days) stent thrombosis occurred in 0.92% (11 of 1,191 patients). A further 0.76% (9 of 1,191 patients) developed late stent thrombosis after 30 days. There were no clinical or angiographic features at the time of the initial procedure that were associated with stent thrombosis as an entire group compared with control group, but early (acute and subacute) stent thrombosis patients had a smaller final stent minimal lumen diameter and longer stent length compared with patients who had late stent thrombosis or controls. Late stent thrombosis occurs in nonbrachytherapy patients and is almost as frequent as early stent thrombosis. Further studies are required to determine whether longer-term poststent pharmacological treatment may decrease or prevent this complication.     

Late angiographic stent thrombosis after sirolimus-eluting stent implantation.

BACKGROUND: Although drug-eluting stents dramatically reduce revascularization after percutaneous coronary intervention (PCI), it is still unclear whether they increase the risk of stent thrombosis. Late stent thrombosis (>30 days) was a very rare complication after bare metal stent implantation. Four cases of confirmed late angiographic stent thrombosis (LAST) after sirolimus-eluting stent (SES) implantation are presented and the incidence, promoting factors and outcomes of such cases in Japan, where clopidogrel has not been approved, are described. METHODS AND RESULTS: Between September 2004 and March 2006, 725 patients underwent PCI with SES implantation and 679 patients (94%) were clinically followed up (median 271 days). There were 4 cases (0.6%) of LAST (at 60, 180, 215, and 508 days, respectively) after elective SES implantation resulting in myocardial infarction. Three cases occurred soon after antiplatelet therapy discontinuation 3 patients died after LAST events. The incidence of LAST was 0.6%. CONCLUSIONS: LAST is a rare complication, even after SES implantation, at least in patients with appropriate antiplatelet therapy. However, as it can lead to fatal complications, it must be taken into account, especially when antiplatelet therapy is discontinued.     

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。     

25例支架内血栓患者的长期随访

目的随访支架内血栓患者的心血管事件及临床预后。方法对2000年3月至2009年12月在北京友谊医院行经皮冠状动脉介入术（PCI）患者（3854例）中,因剧烈胸痛再次入院诊断为急性心肌梗死并经冠状动脉造影证实为支架内血栓形成的25例患者进行长期随访,观察其临床心脏事件（MACE）。结果支架内血栓患者25例,男21例,女4例,平均年龄为（59·5±12·8）岁,其中亚急性血栓8例、晚期血栓3例、极晚期血栓14例。支架内血栓形成后的平均随访时间为（864±775）d。随访期间急性心肌梗死5例,其中4例患者为原支架内再次血栓形成（均为药物涂层支架）,1例患者为血栓靶血管出现新的狭窄;靶病变血管重建4例;靶血管重建1例;左心室收缩功能障碍4例（射血分数EF〈30%,3例为药物涂层支架）。25例患者均存活出院。结论支架内血栓患者发生严重临床心脏事件的概率很高,远期随访问题应值得高度重视。