PCI后晚期血栓合并冠脉痉挛(1)
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【摘要】 目的 探讨PCI后晚期支架血栓合并冠脉痉挛发生冠脉“激惹现象”的处理。方法 采用PCI方法对一名45岁男性非ST段抬高非Q波性急性下壁心肌梗死患者实施支架治疗后一个月,再次冠脉造影发现支架血栓合并冠脉痉挛,并再次PCI处理中发生冠脉“激惹现象”。结果 支架内血栓经PTCA处理和术后抗血小板治疗好转,冠脉痉挛应用硝酸甘油和维拉帕米无效,经多次PTCA后植入支架,效果满意。结论 PCI和应用药物是处理晚期支架内血栓合并冠脉痉挛的有效方法,冠脉“激惹”的处理要慎重。
【关键词】 冠脉支架;血栓;痉挛;激惹现象;PCI
Late thrombosis in stent and coronary spasm after the PCI
LIU Tong-ku.
The cardiovascular center, Affiliated hospital, Beihua university,jilin 132011,China
【Abstract】 Objective To investigate the late thrombosis in stent and coronary spasm after PCI and to occurs"irritation phenomenon"of coronary artery. Methods The patient was a45-year-old man and suffered from acute myocardial infarction without st-elevation and with non q-wave. After one month in the implantation of stents, late stent thrombosis and coronary spasm were found by coronary angiography. During treating with PCI,coronary "irritation phenomenon" happend. Results The stent thrombosis was treated withPTCA and antiplatelet therapy.It was no effective that the coronary spasm treated withnitroglycerin and verapamil, so then the coronary irritation was times treated by PTCA and the result is satisfactory.Conclusion It was effective that the late stent thrombosis and coronary spasm were treated by PCI and the drug. treating the coronary irritation is careful.
【Key words】 Coronary stent; Thrombosis; Spasm; Coronary irritation phenomenon; PCI
作者单位:132011北华大学附属医院心脏中心
经皮冠状动脉介入治疗(PCI)后支架内晚期血栓形成的病例报告并不少见,但同时合并支架外血管严重痉挛,PTCA处理后,其痉挛越发加重,呈现出冠脉“激惹”现象的病例少见。本文结合1例支架内晚期血栓合并支架远端支架外血管痉挛病例处理过程,探讨冠脉“激惹”现象的处理。
1 资料与方法
一名45岁男性,因阵发性胸部闷痛2周,持续性闷痛5 h于2009年09月11日入院。患者于入院前2周起每于活动、上三层楼或劳累时出现胸部闷痛,每次发作持续2 min左右,休息后可自行缓解。于入院前5 h胸闷痛再次发作并持续不缓解急诊入院。既往有高血压病史2年,最高:160/120 mm Hg,口服降压药物可维持血压130/80 mm Hg。
否认糖尿病史。吸烟史20年,吸烟20支/d;饮酒史20年,平均饮酒150~250 ml/d。入院查体:血压150/90 mm Hg,双肺未闻及啰音,心界不大。心率:70次/min,节律规整。心脏各听诊区杂音无。腹软,肝脾不大。双下肢无水肿。心电图示:窦性心律,心电轴不偏,Ⅱ、Ⅲ、avF导联的 T波倒置 。心脏彩超示:心内结构未见异常。血尿酸465 μmol/L,甘油三脂2.28 mmol/L,总胆固醇5.27 mmol/L。肌钙蛋白I2.35 μg/L。诊断:非ST段抬高非Q波性急性下壁心肌梗死。2009年09月14日行常规方法的选择性冠脉造影(CAG)检查示三支病变:右冠3#段100%闭塞,左冠脉前降支(LAD)6-7#段长病变(病变长约40 mm)狭窄80%,左回旋支近段狭窄90%,远段狭窄70%(见图1)。左冠CAG可见来自LAD的侧支循环使右冠末端显影,行右冠回及旋支PCI治疗。
2 手术过程及结果
决定先行右冠回及旋支PCI治疗,择期行LAD的PCI治疗 ......
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