经皮冠状动脉介入术后亚急性支架内血栓形成4例报告并文献复习  

Four cases report of subacute stent thrombosis in the patients with percutanous coronary intervention and literature review

作　　者：田新利[1] 李俊峡[1] 崔振双[1] 石宇杰[1] 石苗茜[1] 徐威[1] 赵冰[1] 马海燕[1] 

机构地区：[1]中国人民解放军陆军总医院心内科,北京100700

出　　处：《中国医刊》2016年第8期31-33,共3页Chinese Journal of Medicine

摘　　要：目的评价和探讨经皮冠状动脉介入术(percutaneous coronary artery intervention,PCI)后亚急性支架内血栓形成的发生机制与相关因素分析。方法回顾性分析本院心内科2013年1月至2016年4月4例PCI后发生亚急性支架内血栓患者的临床情况和发生机制。结果在1800例行PCI的患者中,有4例(0.22%)发生亚急性支架内血栓,其中男2例,女2例,平均年龄72.5岁。4例患者均为择期手术,植入支架均为药物洗脱支架;4例患者在植入支架前均充分预扩张,4例患者亚急性支架血栓形成均经冠状动脉造影证实,平均发病时间在PCI后的3.5天;4例患者均表现为ST段抬高型心肌梗死,3例患者药物由氯吡格雷更换为替格瑞洛,好转出院,1例患者死亡;其中2例患者的血栓弹力图ADP抑制率结果为14%、2.6%。结论 PCI后亚急性支架内血栓的形成可能与患者的年龄、冠状动脉病变的复杂程度以及抗血小板药物抵抗等有关。Objective The aim of this study is to analyse the subacute stent thrombosis and correlation factors in the patient with percutanous coronary intervention. Method We retrospective analysed the clinical characteristics and mechanism of subacute stent thrombosis in the patients with percutanous coronary intervention in our hospital from 2013. 01-2016. 04. Result Four patients（0.22%） took place subacute stent thrombosis in 1800 patients after percutanous coronary intervention, two patients were male and the other two patients were women, the patient＇s mean age was 72.5 years old,all patients performed elective PCI procedure. Drug-eluting stent implanted in 4 patients.The four cases of subacute stent thrombosis all diagnosed by coronary angiography,the clinical situation all presented ST elevation myocardial infaction, the meantime of subacute stent thrombosis was 3.5 days after percutanous coronary intervention.Three patients exchanged clopidogrel to ticagrelor and discharged from hospital,one patient died. Two patients measured by thrombelastogram（TEG）, the TEG result showed the inhibition rate of platelet aggregation were 14% and 2.6% respectively. Conclution The subacute stent thrombosis is association with the patient＇s age, the lesion＇s complexity of coronary artery, procedure and antiplatelet drug resistance. So in our clinical practice, we should pay more attention for this kind of patients.

关 键 词：经皮冠状动脉介入术 亚急性支架内血栓 抗血小板药物抵抗 

分 类 号：R543.31[医药卫生—心血管疾病]