药物洗脱支架置入术后晚期、极晚期支架内血栓形成的光学相干断层成像分析

刘志江, 石蓓, 许官学, 等. 药物洗脱支架置入术后晚期、极晚期支架内血栓形成的光学相干断层成像分析[J]. 临床心血管病杂志, 2019, 35(5): 433-438. doi: 10.13201/j.issn.1001-1439.2019.05.011
引用本文: 刘志江, 石蓓, 许官学, 等. 药物洗脱支架置入术后晚期、极晚期支架内血栓形成的光学相干断层成像分析[J]. 临床心血管病杂志, 2019, 35(5): 433-438. doi: 10.13201/j.issn.1001-1439.2019.05.011
LIU Zhijiang, SHI Bei, XU Guanxue, et al. Optical coherence tomography analysis of late and very late stent thrombosis after drug-eluting stent implantation[J]. J Clin Cardiol, 2019, 35(5): 433-438. doi: 10.13201/j.issn.1001-1439.2019.05.011
Citation: LIU Zhijiang, SHI Bei, XU Guanxue, et al. Optical coherence tomography analysis of late and very late stent thrombosis after drug-eluting stent implantation[J]. J Clin Cardiol, 2019, 35(5): 433-438. doi: 10.13201/j.issn.1001-1439.2019.05.011

药物洗脱支架置入术后晚期、极晚期支架内血栓形成的光学相干断层成像分析

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    通讯作者: 石蓓,E-mail:shibei2147@163.com
  • 中图分类号: R541.4

Optical coherence tomography analysis of late and very late stent thrombosis after drug-eluting stent implantation

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  • 目的:应用光学相关断层成像(OCT)分析药物洗脱支架置入术后晚期、极晚期支架内血栓形成的可能机制。方法:入选2011-01-2017-12经遵义医学院附属医院行冠状动脉(冠脉)造影明确诊断晚期、极晚期支架内血栓形成患者8例。8例患者在PCI术中均行OCT检查。回顾性分析8例患者的临床资料、PCI过程及OCT图像特征。结果:7例伴有多个心血管危险因素,2例合并轻度左心功能不全。首次支架置入至发生支架血栓的平均时间(818±651) d;双联抗血小板服用平均时间(312.8±76.3) d;低密度脂蛋白胆固醇(LDL-C)平均水平为(3.44±1.35) mmol/L,均未达到目标值;1例在术后停用双联抗血小板3个月、2例在服用双联抗血小板期间、5例在单用阿司匹林期间发生支架内血栓;6例置入依维莫司药物支架,1例行支架内非顺应性高压球囊扩张,1例行紫杉醇药物球囊治疗。OCT图像特征:7例患者支架内异质性新生内膜形成,5例为支架内新生动脉粥样硬化伴斑块破裂,2例为支架内新生动脉粥样硬化伴斑块侵蚀;1例出现严重支架贴壁不良,贴壁不良比例达66.2%;6例患者出现不同程度的支架小梁无内膜覆盖,平均为(10.4±6.2)%;5例支架内见红血栓,3例支架内见白血栓。结论:晚期、极晚期支架内血栓患者首次及再次住院多表现为急性冠脉综合征与高LDL-C水平。支架内新生动脉粥样硬化、支架贴壁不良是导致晚期、极晚期支架内血栓形成的主要原因之一。OCT的应用有助于明确晚期和极晚期支架内血栓形成的机制。
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收稿日期:  2018-11-22

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