Bölükbas S, Jähne J, Schirren J
Klinik für Thoraxchirurgie, Dr.-Horst-Schmidt-Kliniken, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Deutschland.
Chirurg. 2009 Jun;80(6):502-7. doi: 10.1007/s00104-008-1656-x.
Percutaneous coronary intervention (PCI) has a special role in the treatment of coronary heart disease. The insertion of drug-eluting stents (DES) requires dual anti-platelet therapy for at least 1 year which makes planned and emergency surgery difficult. There is a dilemma between high risk of stent thrombosis and perioperative bleeding. There is no evidence-based, bridging therapy option available perioperatively. This complex of problems should be considered whenever PCI is performed. An interdisciplinary approach is obligatory in these imminent conditions to proceed with either interventional or surgical revascularization. Co-existing malignancies and disorders which must be treated surgically should be excluded before PCI. Furthermore, DES and dual anti-platelet therapy produce unanswered forensic questions. On legal grounds it is not possible to proceed with surgery in cases of medication with anti-platelet therapy. Therefore, it is mandatory to discuss the possible answers to this problem with health care lawyers. The patient must be informed about this complex of problems.
经皮冠状动脉介入治疗（PCI）在冠心病治疗中具有特殊作用。植入药物洗脱支架（DES）需要至少1年的双重抗血小板治疗，这使得计划性手术和急诊手术都很困难。在支架血栓形成的高风险和围手术期出血之间存在两难境地。围手术期没有基于证据的桥接治疗方案。每当进行PCI时，都应考虑这一系列复杂问题。在这些紧急情况下，必须采取跨学科方法来进行介入性或外科血运重建。在进行PCI之前，应排除并存的必须进行手术治疗的恶性肿瘤和疾病。此外，DES和双重抗血小板治疗还产生了一些尚未解决的法医学问题。从法律角度来看，在使用抗血小板治疗药物的情况下无法进行手术。因此，必须与医疗保健律师讨论这个问题的可能答案。必须告知患者这一系列复杂问题。
