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。

Clinical features of late stent thrombosis after successful sirolimus-eluting stent implantation

OBJECTIVE: To analyze the potential risk factors for patients developing late stent thrombosis (LST) after successful sirolimus-eluting stents (SES) implantation. METHODS: The clinical, angiographic, procedural as well as antiplatelet therapy data were retrospectively analyzed in 8 patients with LST after successful SES implantation. RESULTS: The patient's mean age was (51 +/- 10) years old and indication for SESs was mostly acute coronary syndrome with multiple risk factors of cardiovascular diseases. There was 1 chronic heart failure patient and renal function was normal in all patients. Multivessel diseases and complex coronary lesions including total occlusion lesions, bifurcation lesions and long lesions were seen in these patients. The mean release pressure of stents was (11.60 +/- 1.65) atm and with no high-pressure dilation after the procedure. The median time of dual antiplatelet therapy was (157.5 +/- 41.7) days. The mean duration from SESs implantation to thrombosis was (450.3 +/- 344.7) days. LST developed in 2 patients with active dual antiplatelet therapy, 1 patient at 7 days and 5 patients at 6 months after clopidogrel withdraw, 5 patients presented nonfatal acute myocardial infarction, 1 patient died of acute myocardial infarction after coronary artery bypass grafting. Five patients were successfully treated with second SESs implantations and another one was treated medically. CONCLUSIONS: LST could be safe and effective treated with re-SESs. The development of LST after successful SESs implantation were probably associated with the following factors: (1) acute coronary syndrome with multiple risk factors of cardiovascular diseases and multivessel diseases with complex coronary lesions. (2) Low-pressure deployment without high-pressure dilation after the release. (3) Dual antiplatelet therapy withdraw.