冠状动脉西罗莫司洗脱支架植入术后晚期及超晚期支架内血栓形成的临床研究  

Late and extremely-late in-stent thrombosis formation after sirolimus-eluting stent implantation in coronary artery:a clinical study

作　　者：丁雪燕[1,2] 刘夙璇[1] 秦永文[1] 

机构地区：[1]第二军医大学长海医院心血管内科,上海200433 [2]南京军医杭州疗养院海勤疗区特勤科

出　　处：《介入放射学杂志》2012年第12期1023-1027,共5页Journal of Interventional Radiology

摘　　要：目的分析药物洗脱支架植入后晚期支架内血栓形成(LST)及超晚期支架内血栓形成(VLST)事件的发生率以及临床相关因素。方法长期随访西罗莫司洗脱支架治疗的1 504例患者,分析发生LST的8例患者以及VLST的14例患者的基本临床特征、冠状动脉病变特征及支架植入情况、支架内血栓的发生及治疗情况等。结果西罗莫司洗脱支架置入术后,LST发生率为0.5%(8/1 504),发生于术后(206±85)d,VLST发生率为0.9%(14/1 504),发生于术后(996±611)d。发生支架内血栓患者与未发生晚期支架内血栓患者比较,高血压、糖耐量异常、吸烟、因急性冠脉综合征入院、闭塞病变、分叉病变、弥漫长病变、多支血管病变、植入长支架、多枚支架的发生率差异有统计学意义(P<0.05)。LST与VLST患者比较,胰岛素依赖的糖尿病、吸烟、高血压病的发生率以及发生血栓时的抗血小板治疗的方案差异有统计学意义(P<0.05)。对14例LST和VLST患者中2例行血栓抽吸延迟PCI治疗,余均行直接PCI治疗,所有患者均再次行药物洗脱支架植入术,目前随访均存活。结论高血压、糖耐量异常、吸烟、因急性冠脉综合征入院、闭塞病变、分叉病变、弥漫长病变、多支血管病变、植入长支架、多枚支架是患者发生支架血栓的相关因素,其中糖尿病、吸烟对于VLST的影响不同于LST;支架内血栓形成患者行血栓抽吸及再次植入支架安全、有效。Objective To investigate the incidence and the potential risk factors of the late in-stent thrombosis （LST） and very late in - stent thrombosis （VLST） formation after sirolimus - eluting stent （SES） implantation in coronary artery. Methods A total of 1 504 patients who had received SES implantation were followed up for a long period of time. LST occurred in 8 cases and VLST occurred in 14 cases. The relevant factors, including clinical manifestations, coronary lesion＇ s features, procedure situation, in-stent thrombosis formation and management, were analyzed. Results The incidence of LST was 0.5%, which occurred within （206 ± 85） days after SES implantation, while the incidence of VLST was 0.9%, which occurred within （996 ±611 ） days after SES implantation. The differences in the presence of hypertension, abnormal sugar tolerance test, smoking habit, acute coronary syndrome, multiple risk factors of cardiovascular diseases, multiple vascular diseases, occlusive lesions, bifurcation lesions and longer lesions, use of many stents, etc. were statistically significant between the patients developing in- stent thrombosis and the patients having no LST （P 〈 0.05）. Percutaneous coronary intervention （PCI） was directly carried out in all patients except for two patients who received thrombus aspiration treatment before PCI. The implantation of SES was employed in all patients. The patients were still alive so far. Conclusion Hypertension, abnormal sugar tolerance test, smoking habit, acute coronary syndrome, occlusive lesions, bifurcation lesions, longer lesions, multiple vascular diseases and use of many stents are the risk factors of in-stent thrombosis formation. Smoking habit has different effect on VLST patients and LST patients. Implantation of stent after thrombus aspiration is safe and effective for patients with in- stent thrombosis formation.

关 键 词：冠状动脉疾病 支架 西罗莫司 晚期支架内血栓 超晚期支架内血栓 

分 类 号：R541.4[医药卫生—心血管疾病]