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目的观察西罗莫司洗脱支架冠状动脉内置入术后,支架血栓发生率及临床相关因素。方法2006年4月至2007年8月间,156例患者于首都医科大学大兴医院置入西罗莫司洗脱支架(Cypher select和Firebird支架),84例患者随防1年,72例患者随访半年,明确支架血栓发生情况;分析支架血栓的相关因素及转归。结果早期支架血栓3例(1.92%),晚期支架血栓1例(0.64%)。4例支架血栓患者多支病变(>2支)2例,分叉病变2例,弥漫长病变2例。共置入支架6枚,平均1.5枚/人,平均支架直径(2.88±0.38)mm,平均长度(25.5±6.12)mm,支架释放压力(13.33±1.03)atm,一枚支架置入后行后扩张,术后TIMI血流均为3级。1例术后3d出现介入血管急性ST段抬高心肌梗死,爱通立溶栓后再通并出现休克,置入主动脉气囊反搏治疗5d,现病情平稳;2例分别于术后6d及15d猝死;1例于术后81d猝死。结论156例西罗莫司洗脱支架置入后,早期支架血栓3例,晚期支架血栓1例;表现为急性心肌梗死或猝死;多数患者为急性冠状动脉综合征,多支病变、分叉病变、弥漫长病变,因无血管内超声指导可能遗留残余夹层或支架贴壁不全;发生支架血栓患者预后差,死亡率高。
Objective To observe the incidence of stent thrombosis and its related factors after coronary angioplasty with sirolimus-eluting stent. METHODS: From April 2006 to August 2007, 156 patients received sirolimus-eluting stent (Cypher select and Firebird stent) at Daxing Hospital, Capital Medical University. 84 patients were followed up for one year and 72 patients were followed up Six months, a clear stent thrombosis; analysis of stent thrombosis related factors and prognosis. Results There were 3 cases (1.92%) of early stent thrombosis and 1 case (0.64%) of late stent thrombosis. There were 2 cases with multi-vessel disease (> 2 branches), 2 cases with bifurcation lesions and 2 cases with diffuse lesions in 4 cases of stent thrombosis. A total of 6 stents were placed, with an average of 1.5 pieces / person. The average stent diameter was (2.88 ± 0.38) mm, the average length was (25.5 ± 6.12) mm and the stent release pressure was (13.33 ± 1.03) atm. Expansion, postoperative TIMI blood flow were 3. A case of acute ST-segment elevation myocardial infarction was found in 1 case 3 days after the injection of thrombolysis, and then passed through shock-thrombolytic therapy. After aortic balloon pump was administered for 5 days, the condition was stable. The other two cases were stable at 6 days and 15d sudden death; 1 case died suddenly after 81d. Conclusion 156 cases of sirolimus-eluting stent implantation in early stent thrombosis in 3 cases, late stent thrombosis in 1 case; the performance of acute myocardial infarction or sudden death; most patients with acute coronary syndromes, multivessel disease, bifurcation lesions , Diffuse lesions, due to endovascular ultrasound may remnants of residual dissection or stent adherent incomplete; stent thrombosis patients with poor prognosis, high mortality.