Matsumoto Mitsuaki, Suehiro K, Kubo Y, Onoue G, Komatsubara I, Seito T, Morimoto N, Shiraishi K, Kasai S, Hagioka S, Naito H, Nagae M
Department of Cardiovascular Surgery, Tsuyama Chuo Hospital, Tsuyama, Japan.
Kyobu Geka. 2008 May;61(5):355-8.
An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.
一名82岁男性在左前降支近端（LAD）和右冠状动脉近端（RCA）植入西罗莫司洗脱支架（SES）11天后发生同时性支架血栓形成。患者立即接受了经皮冠状动脉介入治疗；然而，由于复发性支架血栓形成，其病情变得危急，遂紧急进行了大隐静脉移植冠状动脉旁路移植术。术后血管造影显示两支移植血管通畅良好；LAD和RCA内血栓形成呈阴性。由于患者有因服用噻氯匹定导致肝功能障碍的病史，未给予噻吩并吡啶衍生物；这被认为是亚急性支架血栓形成的主要原因。取而代之的是给予患者阿司匹林、西洛他唑和沙格雷酯。仅使用阿司匹林就取得了良好的术后病程。该病例表明，多支血管病变中同时发生SES血栓形成会构成危及生命的情况。
