Al-Dehneh Anthony, Virk Hartaj, Alkhouri Yazan, Hamdan Aiman, Bikkina Mahesh
Department of Cardiology, St. Joseph Regional Medical Center, Seton Hall University, Paterson, New Jersey 07503, USA.
Tex Heart Inst J. 2010;37(3):343-6.
Drug-eluting stents are considered to be superior to bare-metal stents in reducing restenosis rates at 6 months. However, drug-eluting stents appear to be subject to stent thrombosis, a concern that has been reported more frequently in recent times. In November 2003, a 64-year-old man with a medical history of hypertension, type 2 diabetes mellitus, and coronary artery disease underwent percutaneous coronary intervention for the deployment of a sirolimus-eluting stent in the left anterior descending coronary artery. He experienced no complications. More than 4 years later, at age 69, he underwent neurosurgical treatment for a subdural hematoma that resulted from a fall, and he was advised to stop taking aspirin and clopidogrel. Thirty-three days later--1,659 days after stent deployment--he presented with a clinical event that was associated with very late stent thrombosis. After undergoing emergent coronary angiography and the placement of 2 bare-metal stents, he resumed antiplatelet therapy, recovered uneventfully, and was discharged from the hospital in stable condition. To the best of our knowledge, 1,659 days is the longest reported interval between the deployment of a drug-eluting stent and the occurrence of a clinical event that was associated with very late stent thrombosis. Herein, we discuss the case of our patient, review the pertinent medical literature, reinforce the importance of continuous and uninterrupted antiplatelet therapy in drug-eluting stent recipients, and offer considerations regarding the use of drug-eluting stents.
药物洗脱支架在降低6个月时的再狭窄率方面被认为优于裸金属支架。然而，药物洗脱支架似乎易发生支架血栓形成，这一问题在最近的报道中更为频繁。2003年11月，一名有高血压、2型糖尿病和冠状动脉疾病病史的64岁男性接受了经皮冠状动脉介入治疗，在左前降支冠状动脉中植入了一枚西罗莫司洗脱支架。他未出现并发症。4年多后，69岁时，他因跌倒导致硬膜下血肿接受了神经外科治疗，并被建议停用阿司匹林和氯吡格雷。33天后——即支架植入后1659天——他出现了与极晚期支架血栓形成相关的临床事件。在接受紧急冠状动脉造影并植入2枚裸金属支架后，他恢复了抗血小板治疗，顺利康复，并在病情稳定后出院。据我们所知，1659天是报道的药物洗脱支架植入与极晚期支架血栓形成相关临床事件发生之间最长的间隔时间。在此，我们讨论该患者的病例，回顾相关医学文献，强调在药物洗脱支架植入患者中持续和不间断抗血小板治疗的重要性，并提供有关药物洗脱支架使用的考虑因素。
