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目的回顾性分析西罗莫司洗脱支架术后发生极晚期支架内血栓形成患者的临床资料。方法 2002年10月至2005年8月,共612例患者置入835枚西罗莫司洗脱支架,其中4例患者(0.65%)于2006年1至8月发生极晚期支架内血栓形成,导致急性前壁 ST 段抬高的心肌梗死再次入院。回顾性分析该4例患者的临床情况、抗血小板药物应用情况、造影结果以及 PCI 过程等相关资料。结果 4例患者均为男性,年龄40～69岁,血栓发生时间为术后31～37个月。患者第一次支架术后服用氯吡格雷7～12个月,其中1例患者血栓发生前18个月停用阿司匹林。支架置入部位均为前降支,急诊造影提示支架内闭塞,局部可见明显血栓征象,前向血流 TIMI 0级,均再次行 PCI 治疗后存活。结论药物洗脱支架术后可以发生极晚期血栓形成,药物洗脱支架术后的远期随访问题值得重视。
Objective To retrospectively analyze the clinical data of patients with very late stent thrombosis after sirolimus-eluting stent. Methods From October 2002 to August 2005, a total of 612 patients received 835 sirolimus-eluting stents. Of the 4 patients (0.65%) who developed very late stent thrombosis from January to August 2006, Myocardial infarction leading to acute anterior ST-segment elevation was re-admitted. Retrospective analysis of the 4 cases of patients with clinical conditions, antiplatelet drug application, angiography results and PCI related information. Results All the 4 patients were male, aged 40-69 years. The time of thrombosis was 31-37 months after operation. Patients received clopidogrel for 7 to 12 months after their first stenting, and 1 patient discontinued aspirin 18 months before thrombosis. Stent placement were anterior descending artery, emergency radiography prompted stent occlusion, local obvious signs of thrombosis, the antegrade flow TIMI grade 0, were again PCI after survival. Conclusion The late-stage thrombosis may occur after drug-eluting stents. The long-term follow-up after drug-eluting stents is worthy of attention.