Dieter R S
University of Wisconsin Madison, Department of Medicine, USA.
Clin Cardiol. 2000 Nov;23(11):808-10. doi: 10.1002/clc.4960231129.
This paper aimed to examine the literature for cases of coronary artery stent infection in order to provide comprehensive data to clinicians regarding its prevalence, clinical presentations, and possible treatments. Coronary artery stenting was initially reported in 1987. Stenting of the coronary arteries is now used in 40-60% of all interventional coronary artery procedures. The understanding of the pathophysiology of coronary artery disease is evolving. It has been suggested that atherosclerosis may be a complication of an infectious etiology. By using a stent to treat coronary artery disease, a foreign body is directly juxtaposed with an area of inflammation. The first reported case of an infected coronary artery stent was in 1993. Although this is an exceedingly rare event, the associated mortality is alarmingly high. Analysis of the literature reveals a total of four reported cases of coronary artery stent infection. Symptoms of stent infection present days to weeks after the initial coronary intervention. All four patients developed fevers and at least two patients developed postintervention angina. In patients who have had a coronary artery stented, the presence of angina and fevers should make the clinician suspicious for a stent-related infection. Two of the patients had infection with Pseudomonas aeruginosa, which seems to be an unusual organism for a catheter-related infection. Surgical removal of the infected stent and artery complex was performed on nearly all cases. Despite aggressive measures, the majority of patients died. Few data are available on the long-term risk for coronary artery stent infection. In a patient who has undergone coronary artery stent placement, the clinician must be very sensitive to fever, return of angina, and bacteremia. The complication rate at the present time does not warrant the use of prophylactic antibiotics prior to high-risk procedures (e.g., dental procedures). Furthermore, the low infection rate of coronary artery stents may be a result of the inflammatory nature of atherosclerosis, which may provide a protective benefit against bacterial infection of the stent.
本文旨在查阅有关冠状动脉支架感染病例的文献，以便为临床医生提供关于其患病率、临床表现及可能治疗方法的全面数据。冠状动脉支架植入术最初于1987年被报道。目前，在所有冠状动脉介入手术中，40% - 60%的手术会使用冠状动脉支架植入术。对冠状动脉疾病病理生理学的认识正在不断发展。有人提出动脉粥样硬化可能是感染性病因的一种并发症。通过使用支架治疗冠状动脉疾病，异物直接与炎症区域相邻。首例报道的感染冠状动脉支架病例发生于1993年。尽管这是极为罕见的事件，但其相关死亡率却高得惊人。对文献的分析显示，总共报道了4例冠状动脉支架感染病例。支架感染的症状在初次冠状动脉介入术后数天至数周出现。所有4例患者均出现发热，且至少2例患者出现介入术后心绞痛。对于已进行冠状动脉支架植入的患者，若出现心绞痛和发热，临床医生应怀疑与支架相关的感染。其中2例患者感染铜绿假单胞菌，这似乎是一种不常见的与导管相关感染的病原体。几乎所有病例均进行了感染支架及动脉复合体的手术切除。尽管采取了积极措施，但大多数患者仍死亡。关于冠状动脉支架感染的长期风险，现有数据很少。对于已接受冠状动脉支架植入的患者，临床医生必须对发热、心绞痛复发及菌血症高度敏感。目前的并发症发生率并不足以支持在高风险手术（如牙科手术）前使用预防性抗生素。此外，冠状动脉支架的低感染率可能是动脉粥样硬化炎症性质的结果，这可能对支架的细菌感染具有保护作用。
