药物涂层支架晚期血栓形成相关因素的分析

目的 探讨药物涂层支架（DES）晚期血栓形成的相关因素.方法 分别纳入我院2008年1月～2013年1月DES置入术后发生晚期血栓患者30例（血栓组）和置入DES 1年以上未发生支架内血栓患者30例（对照组）,通过64SCT冠状动脉成像观测支架贴壁情况、支架置入部位个数及长度与直径,采集病史分析晚期血栓的危险因素.结果 与对照组相比,血栓组支架贴壁不良发生率（60.0%vs.10.0%）、采用挤压支架技术（crush技术）比例（36.7% vs.13.3%）、分叉病变发生率（43.3% vs.16.7%）、多支架（＞4）置入比例（33.3% vs.0）均较高;支架平均长度较长（39.2±20）mm vs.（21.7±7）mm],同时支架平均直径也较大（3.0±0.5）mm vs.（2.5±0.5）mm],差异均有统计学意义（P＜0.05）;另外,血栓组合并左室射血分数减低、糖尿病、肾功能不全及过早停用双重抗血小板治疗的发生率明显高于正常组,有统计学差异（P＜0.05）.结论 DES晚期血栓形成与多种因素有关,包括复杂病变、置入支架过多、过长等,同时还与糖尿病、肾功能不全、抗凝不足等具有相关性.

Research about the relevant factors of late thrombosis in drug-eluting stents

Objective To investigate the relevant factors of late thrombosis in drug-eluting stents （DES）. Methods The patients （ n=30 ） with late thrombosis in stent after DES implantation （ thrombosis group ） and patients （ n=30 ） without thrombosis instent for at least 1 year （ control group ） were chosen from Jan. 2008 to Jan. 2013. and the adherent situation and stent position as well as the length and diameter were all coneulated by 64 SCT, meanwhile the history of all the patients were collcted for further analysis. Results Compared with control group, the incidence of DES malapposition （ 60.0% vs. 10.0% ） , ratio of applying squeezing bracket technique （ 36.7% vs. 13.3% ） , incidence of bifurcation lesion （ 43.3% vs. 16.7% ） , and implantation ratio of multiple DES （ 〉4, 33.3% vs. 0 ） were all higher in thrombosis group, and at the same time, the average stent length was longer （ 39.2 ± 20 ） mm vs. （ 21.7 ± 7 ） mm] and average stent diameter was larger （ 3.0 ± 0.5 ）mm vs. （ 2.5 ± 0.5 ） ram, P〈0.05], The incidences of complicated decrease of left ventricular ejection fraction （ LVEF ） , diabetes, renal insufficiency and premature discontinuation of dual antiplatelet treatment were all higher in thrombosis group than those in control group. Conclusion There＇re many factors for the thrombosis in DES, including complex lesions, stenting too much or too long, as well as the history of diabetes, renal insufficiency, also lack of antieoagulation.