雷帕霉素洗脱支架远期致冠状动脉局部血管瘤样扩张四例报告  

Late localized aneurismal dilations after sirolimus-eluting stents in 4 patients

作　　者：柳弘[1] 吕树铮[1] 陈韵岱[1] 苑飞[1] 李晶[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2007年第1期44-46,共3页Chinese Journal of Cardiology

摘　　要：目的分析雷帕霉素洗脱支架远期发生冠状动脉局部血管瘤样扩张的特点及原因。方法 2004年4—7月接受介入治疗的冠心病患者4例,男3例,女1例,造影显示7支病变血管共置入9个支架,其中前降支置入 Cypher select 支架5个,回旋支置入 Firebird 支架2个,Pixel 支架1个,右冠状动脉置入 Cypher select 支架1个。术后口服氯吡格雷 75 mg/d 持续1年。结果 4例均成功置入支架,病变血管达 TIMIⅢ级血流灌注,心绞痛症状消失,无急性/亚急性血栓形成。平均随访(24.8±1.8)个月,无主要心脏不良事件发生。术后12个月冠状动脉造影随访,无支架内再狭窄及新病变出现。停用氯吡格雷,继续门诊随访,病情稳定。4例患者分别于术后16、18、22个月因心绞痛症状复发而再次入院,人院后给予氯吡格雷75 mg/d,静脉注射硝酸甘油及皮下注射低分子肝素治疗。冠状动脉造影显示:3例于前降支近段,1例右冠状动脉中段置入 Cypher 支架的部位冠状动脉呈血管瘤样扩张,扩张处血管直径明显大于临接正常冠状动脉,其他置入支架的血管无病变。术后即刻给予替罗非班(0.1μg·kg^(-1)·min^(-1))连续3天治疗,症状消失。继续随访3～6个月,全部存活,无心绞痛发生。结论雷帕霉素支架远期发生支架贴壁不良,导致血管重构是造成局部血管瘤样扩张的可能原因。Objective To analyze the reason of coronary artery aneurismal dilations in patients after sirolimus-eluting stent implantation. Methods Late localized aneurismal dilations post PCI were evidenced in 4 patients （ age 69.5 ± 3. 5 years, 3 males） during follow-up （ 24. 8 ± 1.8 months）. Nine stents were implanted into 7 diseased vessels ： 5 Cypher select stents in LAD; 2 Firebird stents and 1 Pixel stent in LCX; 1 Cypher select stent in RCA. Clopidogrel （75 mg/d） was used for one year. Results All stems were implanted succesfully after predilation. No acute or subacute in-stent thrombosis and MACE was recorded. Follow-up angiogram imaging at 12 months after stenting was normal in all patients. Chest pain reoccurred in these 4 patients at 16, 18, and 22 months post stent implantation and patients were rehospitalized and treated with clopidogrel, asprine, and intravenous nitroglycerin. Angiography showed aneurismal segment at the stented site of LAD in 3 patients, and at RCA in 1 patient. The symptom disappeared after 3 days intravenous tirofiban treatments and discharged without in-hospital complications. Patients remained symptom-free 3 - 6 months post discharge. Condnsion Late localized aneurismal dilations after sirolimus-duting stents are related to reoccurred angina pectoris post PCI.

关 键 词：冠状动脉疾病 支架 西罗莫司 血管重构 

分 类 号：R543[医药卫生—心血管疾病]