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目的:分析支架内血栓形成病例的临床特点并探讨其原因。方法:收集自2007-04至2008-06的所有支架内血栓的患者,共12例。其中男性10例,女性2例。1例置入金属裸支架,其余11例均为药物涂层支架。分析入选病例的临床特点,冠状动脉病变特征。结果:12例患者中,亚急性血栓5例;晚期血栓4例;极晚期血栓3例。分析病变特点及血栓形成原因显示:在早期血栓形成的5例中4例为原发性支架贴壁不良、支架膨胀不良、未完全覆盖病变;1例为糖尿病、长病变、完全闭塞病变。在晚期和极晚期血栓形成的7例病例中3例因为停用了波立维;2例有支架内严重再狭窄;1例为正性重构、获得性贴壁不良;1例为糖尿病、小血管病变,且支架中段扩张不充分不除外贴壁不良的因素。结论:支架内血栓是金属裸支架和药物涂层支架置入术后很少发生但非常严重的并发症。急性的支架内血栓可能与贴壁不良有关。晚期支架内血栓在病因学上是多因素的,主要与双联抗血小板药物治疗依从性相关。
Objective: To analyze the clinical characteristics of thrombosis cases and to explore its causes. METHODS: All patients with stent thrombosis collected from 2007-04 to 2008-06 were enrolled, a total of 12 patients. Including 10 males and 2 females. One patient was placed in a bare metal stent and the remaining 11 patients were drug-coated stents. Analysis of selected cases of clinical features, coronary lesions. Results: Of the 12 patients, 5 were subacute thrombosis, 4 were late thrombosis, and 3 were very late thrombosis. Analysis of the characteristics of the lesion and the causes of thrombosis showed that in the 5 cases of early thrombosis, 4 cases had poor adherence to the primary stent and poor stent dilatation, which did not completely cover the lesion; 1 case had diabetes, long pathological changes and complete occlusion. In 7 of the late and very late thrombosis cases, 3 were discontinued with polio; 2 had severe in-stent restenosis; 1 was positive remodeling and acquired adherent dysplasia; 1 was diabetes and was small Vascular lesions, and stent expansion in the middle is not inadequate except for poor adherence factors. Conclusions: Intra-stent thrombosis is a rare but very serious complication after bare-metal and drug-coated stents. Acute stent thrombosis may be related to poor adherence. Late stent thrombosis in the etiology is multifactorial, mainly associated with dual antiplatelet drug treatment compliance.