西罗莫司洗脱支架术后极晚期血栓形成四例分析

目的回顾性分析西罗莫司洗脱支架术后发生极晚期支架内血栓形成患者的临床资料。方法2002年10月至2005年8月,共612例患者置入835枚西罗莫司洗脱支架,其中4例患者（0．65％）于2006年1至8月发生极晚期支架内血栓形成,导致急性前壁ST段抬高的心肌梗死再次入院。回顾性分析该4例患者的临床情况、抗血小板药物应用情况、造影结果以及PCI过程等相关资料。结果4例患者均为男性,年龄40～69岁,血栓发生时间为术后31～37个月。患者第一次支架术后服用氯吡格雷7～12个月,其中1例患者血栓发生前18个月停用阿司匹林。支架置入部位均为前降支,急诊造影提示支架内闭塞,局部可见明显血栓征象,前向血流TIMI0级,均再次行PCI治疗后存活。结论药物洗脱支架术后可以发生极晚期血栓形成,药物洗脱支架术后的远期随访问题值得重视。

Very late stent thrombosis after implantation of sirolimus eluting coronary stents

OBJECTIVE: To analyze the clinical date of 4 patients who developed very late stent thrombosis after implantation of sirolimus eluting stents. METHODS: From Oct. 2002 to Aug. 2006, 835 sirolimus eluting stents were implanted in 612 patients. From Jan. 2006 to Aug. 2006, very late thrombosis in sirolimus eluting stents occurred in 4 patients (0.65%), and which caused acute myocardial infarction in anterior wall. Emergency percutaneous coronary interventions (PCIs) were performed in 4 patients immediately after re-admission. The clinical date of the 4 cases were analyzed retrospectively. RESULTS: These 4 patients were male with the age of 40-69 years. Very late stent thrombosis occurred 31-37 months after successful implantation of sirolimus eluting stents. Application of clopidogrel was stopped 7-12 months after first stents implantation. Aspirin was continued in 3 patients, while the other patient discontinued taking aspirin 18 moths before thrombosis occurred. Emergency coronary angiogram showed that sirolimus eluting stents in LADs were all occlude by thrombosis with TIMI 0 flow. All 4 patients survived after successfully primary PCIs. CONCLUSIONS: Our report presents evidence of very late thrombosis in sirolimus eluting coronary stents, and more careful and prolonged flow-up was required in patients after implantation of drug eluting stents.