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目的观察导管血栓抽吸联合冠脉支架置入治疗急性心肌梗死(AMI)疗效。方法对122例AMI冠脉支架置入治疗病人中的43例急性ST段抬高型AMI(STEMI)患者常规进行冠脉造影术后,确定梗死相关动脉(IRA),见闭塞病变近端均有大量血栓征象。先用DiverCE装置血栓抽吸导管抽吸血栓,再使用球囊扩张狭窄病变并置入支架,或抽吸后直接置入支架。观察置入支架前后TIMI血流、缺血性胸痛缓解、心电图ST段回落情况,并用超声心动图评估左心室射血分数。结果 43例病人术前冠脉造影显示IRA的前向血流TIMI0级38例,TIMI1级4例,TI-MI2级1例。经导管反复血栓抽吸,31例抽出不同量的肉眼血栓,抽吸后造影显示IRA的前向血流TIMI3级26例,TIMI2级15例,TIMI1级2例,与术前比较TIMI血流明显改善(P<0.01)。术后1h内缺血性胸痛完全缓解;经皮冠状动脉介入治疗(PCI)术后1h复查心电图,缺血明显改善,ST段回落率>70%;术后1个月超声心动图评估左心室射血分数为(52.00±5.63)%;临床随访6个月～1年,1例术后支架内再狭窄,42例病人无主要不良事件(死亡、再梗死、靶血管重建、卒中等)发生。结论 STEMI患者实施PCI术前采用DiverCE装置导管血栓抽吸术可去除血栓负荷,改善心肌组织的再灌注,提高PCI的实际成功率,该手术具有简便易行、有效且相对价格较低的优点。
Objective To observe the curative effect of catheterization of thrombus aspiration and coronary stenting in the treatment of acute myocardial infarction (AMI). Methods Forty-three patients with acute ST-elevation AMI (STEMI) treated with AMI coronary stenting were enrolled in this study. Conventional coronary angiography was performed to determine the infarct-related artery (IRA) Massive thrombus signs. Thrombectomy catheter with DiverCE device first suction thrombus, and then use the balloon dilatation and stenosis into the stent, or suction directly into the stent. The TIMI blood flow, the relief of ischemic chest pain and ST-segment depression were observed before and after stent placement. Left ventricular ejection fraction was assessed by echocardiography. Results The preoperative coronary angiography of 43 patients showed that there were 38 cases of TIMI0 grade, 4 cases of TIMI1 grade and 1 case of TI-MI2 grade in IRA. Thirty-two patients underwent thrombus aspiration and thoracotomy. Thirty-two patients underwent gross thrombus embolization after thoracotomy, and 26 patients with TIMI grade 3, 15 TIMI2 grade and 2 TIMI grade grade, Improve (P <0.01). The ischemic chest pain was completely relieved within 1 hour after operation. The electrocardiogram was re-examined at 1 hour after percutaneous coronary intervention (PCI), the ischemia improved significantly and the ST-segment resolution was> 70%. The left ventricle The ejection fraction was (52.00 ± 5.63)%. Clinical follow-up ranged from 6 months to 1 year. One patient had in-stent restenosis and 42 patients had no major adverse events (death, reinfarction, target vessel reconstruction, stroke, etc.) . Conclusion The use of DiverCE device catheter thrombectomy before STEMI in patients with STEMI can remove thrombus load, improve myocardial tissue reperfusion, and improve the actual success rate of PCI. The operation is simple, effective, and relatively inexpensive.