The Heart Center of Chonnam National University Hospital, Gwangju, Korea.
Korean Circ J. 2009 May;39(5):205-8. doi: 10.4070/kcj.2009.39.5.205. Epub 2009 May 28.
Drug-eluting stents (DESs) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. However, late stent thrombosis seems to occur more frequently with DESs and is closely associated with the discontinuation of dual antiplatelet therapy. We report a case of very late stent thrombosis after discontinuation of dual antiplatelet therapy. The patient suffered from acute myocardial infarction (MI) and underwent bare metal stent (BMS) implantation in the left anterior descending artery (LAD) five years prior to presentation. Three years after BMS implantation, he presented again with acute MI and had a DES implanted in the right coronary artery (RCA). He ran out of his medication, but failed to refill his prescription. Sixteen days after discontinuing medication, he experienced an episode of chest pain and was taken to the cardiac catheterization laboratory, where he was found to have thrombosis in the DES, but no thrombosis in the BMS. It is possible that DESs are more vulnerable to late thrombosis than are BMSs, supporting the use of prolonged dual antiplatelet therapy in patients treated with DESs. The patient was successfully treated with balloon angioplasty and thrombus aspiration without complications.
药物洗脱支架（DESs）是经皮介入治疗可行时治疗阻塞性冠状动脉疾病的首选方法。然而，DES 似乎更容易发生晚期支架血栓形成，且与双联抗血小板治疗的中断密切相关。我们报告了一例停用双联抗血小板治疗后发生的非常晚期支架血栓形成病例。该患者在就诊前五年因急性心肌梗死（MI）而行左前降支（LAD）的金属裸支架（BMS）植入术。BMS 植入后三年，他再次因急性 MI 就诊，并在右冠状动脉（RCA）植入 DES。他的药物已经用完，但未能补充处方。停药 16 天后，他出现胸痛发作，并被送往心脏导管室，发现 DES 中有血栓，但 BMS 中没有血栓。DES 比 BMS 更容易发生晚期血栓形成，这支持对接受 DES 治疗的患者使用延长的双联抗血小板治疗。患者通过球囊血管成形术和血栓抽吸术成功治疗，无并发症。
