Department of Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
Korean Circ J. 2009 Oct;39(10):439-42. doi: 10.4070/kcj.2009.39.10.439. Epub 2009 Oct 28.
A 55-year-old male patient presented with an acute myocardial infarction. A sirolimus-eluting stent (SES) was implanted in the proximal left anterior descending artery (LAD). Eight months later, there was a newly developed distal LAD lesion. An additional SES was implanted. Twenty-eight months after the index procedure of primary coronary intervention, the electrocardiogram showed ST elevation in the precordial leads and an emergency coronary angiogram showed diffuse stent thrombosis (ST) in the proximal LAD. Thirty-four months after the index procedure, coronary angiography showed a large peri-stent coronary aneurysm in the proximal LAD and focal in-stent restenosis (ISR) at the proximal edge of the distal LAD stent. On fluoroscopy, a fracture was noted in the middle part of the distal SES. A zotarolimus- eluting stent (ZES) was deployed and overlapped the restenosis and fracture sites. Forty months after the index procedure, there were no changes in the size of the aneurysm or in the other stent complications including the fracture and restenosis. At present, the patient has remained asymptomatic for eight months.
一位 55 岁男性患者因急性心肌梗死就诊。在其左前降支（LAD）近端植入了一个西罗莫司洗脱支架（SES）。八个月后，LAD 远端出现新的病变。再次植入一个 SES。在初次经皮冠状动脉介入治疗后的 28 个月，心电图显示心前区导联 ST 段抬高，紧急冠状动脉造影显示 LAD 近端弥漫性支架血栓形成（ST）。初次经皮冠状动脉介入治疗后 34 个月，冠状动脉造影显示 LAD 近端支架附近有一个大的支架周围动脉瘤和 LAD 远端支架近端边缘的局灶性支架内再狭窄（ISR）。透视下发现远端 SES 的中部有一处断裂。植入了一个佐他莫司洗脱支架（ZES），并覆盖了再狭窄和断裂部位。初次经皮冠状动脉介入治疗后 40 个月，动脉瘤大小或其他支架并发症（包括断裂和再狭窄）没有变化。目前，患者无任何症状已持续 8 个月。
