西罗莫司洗脱支架置入术后血栓发生率及相关因素分析  

Incidence and risk factors of stent thrombosis after sirolimus-eluting stent implantation

作　　者：祝红秋[1] 肖月[1] 郭艳娟[1] 王晶锐[1] 梁峰[1] 胡大一[2] 吴明营[3] 李田昌[3] 汤楚中[2] 尹荣秀[2] 王吉云[3] 卢长林[3] 

机构地区：[1]首都医科大学大兴医院,北京市102600 [2]北京大学人民医院,北京市100044 [3]首都医科大学附属北京同仁医院,北京市107600

出　　处：《中华老年多器官疾病杂志》2009年第4期325-328,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的观察西罗莫司洗脱支架冠状动脉内置入术后,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。Objective To determine the incidence and risk factors of stent thrombosis（ST） after sirolimus-eluting stent （SES） implantation. Methods A total of 156 patients who received percutaneous coronary intervention procedure with SES implantation between Apr 2006 to Aug 2007 in our hospital were evaluated. Angiographic and procedural outcome were documented by interventional cardiologist, the clinical outcome was recorded before discharge. Clinical follow-up was carried out for 6 months in 72 patients and for 1 year in 84 patients, to investigate the incidence, risk factors and outcome of ST. Results Four patients had suffered from ST： 3 patients（1.92%） were early ST, 1 patient（0.64%） was late ST. From the 4 patients there were 2 multivessel diseases, 2 bifurcation lesions and 2 long diffuse lesions patients. Six stents were implanted, mean stents diameter was （2.88± 0.38）mm, mean stents length was （25.5±6.12）ram and mean release pressure of stents was （13.33±1.03）arm with 1 high-pressure post-dilation, TIMI grade 3 flow was achieved after procedure in all 4 patients. One patient presented acute ST-elevation myocardial infarction 3d after procedure and received rt-PA and IABP treatment, now survives without any events; 3 patients suffered from sudden death 6 d, 15d and 81d after the procedure respectively. Conclusion In our study, 3 developed early ST and 1 late ST in 156 patients after SES implantation. The clinical presentation is acute myocardial infarction or sudden death. The development of ST after SES implantation is probably associated with the following factors.. （1） acute coronary syndrome with multivessel diseases, bifurcation lesions or long diffuse lesions; （2） the presence of residual dissection or stent under-expansion without intravascular ultrasound assessments. Coronary ST is a catastrophic complication after percutaneous coronary intervention, and the mortality is high.

关 键 词：冠状动脉疾病 支架 西罗莫司 血栓形成 

分 类 号：R54[医药卫生—心血管疾病] R541.4[医药卫生—内科学]