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目的分析冠状动脉药物洗脱支架置入后晚期支架内血栓形成的临床相关因素。方法回顾性分析2003年7月至2005年1月我院置入西罗莫司洗脱支架的1304例冠心病患者中发生晚期支架内血栓的8例患者的临床资料、冠状动脉病变特点、支架释放情况以及术后的抗血小板治疗等相关因素。结果 8例患者平均年龄(51±10)岁、7例为急性冠状动脉综合征患者且伴有多项心血管病危险因素,仅1例患者伴有左室功能不全,无肾功能不全患者;多支冠状动脉病变患者6例且病变较复杂,包括闭塞、分叉、开口和弥漫长病变;支架释放压力平均(1175.37±167.19)kPa(11.60±1.65 atm),全部患者未用高压球囊进行后扩张;双重抗血小板治疗平均时间为(157.5±41.7)d,1例在停用氯吡格雷第7天、2例在服用阿司匹林和氯吡格雷治疗期间、5例停用氯吡格雷6个月后出现支架内血栓,平均血栓发生时间为术后(450.3±344.7)d,5例表现为急性心肌梗死;1例死亡,5例再次置入西罗莫司洗脱支架,术后随访无症状,1例药物治疗。结论发生晚期支架内血栓的冠心病患者多表现为急性冠状动脉综合征、伴有多项心血管病危险因素;多支、复杂冠状动脉病变;支架低压释放,置入后未行后扩张;双重抗血小板治疗时间短。发生晚期支架内血栓患者预后差,死亡率较高,再次置入西罗莫司洗脱支架是安全、有效的。
Objective To analyze the clinically relevant factors of late stent thrombosis after coronary stent implantation. Methods The clinical data of 8 patients with advanced stent thrombosis in 1304 patients with coronary artery disease treated with sirolimus-eluting stent in our hospital from July 2003 to January 2005 were analyzed retrospectively. The characteristics of coronary lesion, Release and postoperative antiplatelet therapy and other related factors. Results The average age of the 8 patients (51 ± 10) years old, 7 patients with acute coronary syndrome and a number of cardiovascular risk factors, only 1 patient with left ventricular dysfunction without renal insufficiency; Six patients with multivessel coronary artery disease were complicated with lesions including occlusion, bifurcation, opening and diffuse lesions. The stent release pressure averaged (1175.37 ± 167.19) kPa (11.60 ± 1.65 atm), and all patients were not treated with high pressure balloon (157.5 ± 41.7) days in double antiplatelet therapy, 1 case stopped clopidogrel on the 7th day, 2 cases stopped taking aspirin and clopidogrel during treatment, 5 cases stopped using 6 clopidogrel Thrombolysis occurred after the month. The mean time to thrombosis was (450.3 ± 344.7) days after operation, 5 cases showed acute myocardial infarction, 1 died and 5 cases were re-placed with sirolimus-eluting stent. No postoperative follow-up was found Symptoms, 1 case of medication. Conclusions Patients with late-stage stent thrombosis in patients with coronary heart disease often show acute coronary syndrome, with a number of risk factors for cardiovascular disease; multiple branches and complex coronary lesions; stent low-pressure release, did not expand after implantation; Antiplatelet therapy is short. Patients with advanced stent thrombosis have poor prognosis and high mortality, and re-placement of sirolimus-eluting stents is safe and effective.