一例冠状动脉支架置入术后19个月出现晚期支架内血栓形成并表现为急性心肌梗死的病例报告。

A case report of late coronary stent thrombosis manifested as acute myocardial infarction 19 months after stenting.

作者信息

Ishikawa Tetsuya, Mori Chikara, Abe Yuichi, Aramaki Kazuhiko, Takeda Hiroshi, Tanaka Yasuyuki, Sugiura Tohru, Yagi Hidenori, Seo Atsushi, Shibata Takahiro, Yoshida Satoru, Mochizuki Seibu

机构信息

Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.

出版信息

Jpn Heart J. 2004 Jan;45(1):147-52. doi: 10.1536/jhj.45.147.

DOI:10.1536/jhj.45.147

PMID:14973359

Abstract

A 63-year-old Japanese man was readmitted to our hospital due to acute broad-anterior myocardial infarction (AMI). The proximal left anterior descending artery (LAD) at the prior stent, which was implanted 19 months earlier and in which no angiographic restenosis was recognized 13 months before the second study, was totally occluded. After crossing a guide wire and balloon angioplasty, angiographic radiolucency was observed at the prior stent, suggesting that AMI was induced by late coronary stent thrombosis. Intravascular ultrasound performed 19 days after the onset of AMI revealed superficial calcification without significant stenosis and an atherosclerotic plaque distal to the stent that was not significantly changed compared to 19 months previously, consistent with the culprit lesion being an intrastent site. AMI may thus be induced by late coronary stent thrombosis during long-term clinical follow-up without clinical symptoms or angiographic restenosis at the second study.

摘要

一名63岁的日本男性因急性广泛前壁心肌梗死（AMI）再次入院。之前植入支架的左前降支（LAD）近端完全闭塞，该支架于19个月前植入，在第二次检查前13个月未发现血管造影显示的再狭窄。在穿过导丝并进行球囊血管成形术后，在之前的支架处观察到血管造影不显影，提示AMI是由晚期冠状动脉支架血栓形成所致。AMI发病19天后进行的血管内超声检查显示有浅表钙化但无明显狭窄，支架远端有一个动脉粥样硬化斑块，与19个月前相比无明显变化，这与罪犯病变位于支架内部位一致。因此，在长期临床随访期间，AMI可能由晚期冠状动脉支架血栓形成引起，而在第二次检查时无临床症状或血管造影再狭窄。