Zhang Feng, Qian Juying, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Shangai, China.
Int Heart J. 2007 Sep;48(5):591-6. doi: 10.1536/ihj.48.591.
Late stent malapposition (LSM) has been demonstrated to be more common after drug-eluting stent (DES) implantation than after bare-metal stent (BMS) implantation. To date, this unusual intravascular ultrasonic finding after DES implantation, however, has not received enough attention, because previous studies suggested few adverse clinical sequelae from LSM. We present a case of angiographically-confirmed very late stent thrombosis (ST) in LSM after elective implantation of sirolimus-eluting stents. In this 32-year-old male patient, very late ST occurred at 29 months after DES implantation and at 20 months after the identification of LSM. Although this patient had received sufficient dual antiplatelet therapy with aspirin and clopidogrel for more than 1 year, he suffered from ST shortly after the discontinuation of clopidogrel. Thus, patients with LSM may pose a significant risk for very late ST after discontinuation of dual antiplatelet therapy. The findings suggest that dual antiplatelet therapy should be further prolonged in patients with LSM.
晚期支架贴壁不良（LSM）已被证明在药物洗脱支架（DES）植入后比裸金属支架（BMS）植入后更常见。然而，迄今为止，DES植入后这种不寻常的血管内超声表现尚未得到足够重视，因为先前的研究表明LSM几乎没有不良临床后果。我们报告一例在选择性植入西罗莫司洗脱支架后出现血管造影证实的LSM极晚期支架血栓形成（ST）的病例。在这位32岁男性患者中，极晚期ST发生在DES植入后29个月以及LSM确诊后20个月。尽管该患者接受阿司匹林和氯吡格雷充分双联抗血小板治疗超过1年，但在停用氯吡格雷后不久即发生ST。因此，LSM患者在停用双联抗血小板治疗后可能面临极晚期ST的重大风险。这些发现提示，对于LSM患者应进一步延长双联抗血小板治疗时间。
