Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom.
Catheter Cardiovasc Interv. 2012 Jul 1;80(1):59-64. doi: 10.1002/ccd.23184. Epub 2011 Dec 8.
We studied the acute safety and feasibility of a pericardium-covered stent (PCS) in the obliteration of massive coronary thrombus.
Thrombus is frequently encountered in the setting of acute myocardial infarction, and conventional pharmacological and aspiration approaches are not always successful in dispersing or removing it, especially when it is very substantial.
We treated nine patients (10 lesions) in the setting of an acute coronary syndrome characterized by the presence of substantial (TIMI grade 3-4) thrombus in a large caliber native coronary artery, persisting after conventional treatment, with percutaneous implantation of an equine PCS graft. Nine of 10 lesions were in large right coronary arteries.
Deployment was successful in nine of 10 lesions. In all nine cases, the filling defect was immediately eliminated and there was restoration or maintenance of TIMI grade 3 blood flow. There was one in-hospital stent thrombosis in a 56-year-old male, who had only received aspirin due to a coexistent stroke. This patient underwent successful repeat percutaneous intervention but died later of complications of the stroke. There were no 30-day events, and medium-term follow-up continues.
A PCS graft is a potentially useful device to treat massive thrombus burden in the setting of acute coronary syndrome. A larger study is warranted.
我们研究了心包覆盖支架（PCS）在大块冠状动脉血栓闭塞中的急性安全性和可行性。
血栓在急性心肌梗死中经常遇到，常规的药物和抽吸方法并不总是能成功地分散或清除血栓，尤其是当血栓非常大时。
我们在急性冠状动脉综合征患者中使用了心包覆盖支架，这些患者的特征是存在大量（TIMI 3-4 级）血栓，位于大口径原生冠状动脉内，在常规治疗后仍持续存在，采用经皮植入马心包 PCS 移植物。10 个病变中有 9 个位于右冠状动脉。
10 个病变中有 9 个成功植入。在所有 9 例中，充盈缺损立即消除，TIMI 血流分级恢复或维持在 3 级。一名 56 岁男性在住院期间发生支架内血栓形成，由于同时患有中风，只接受了阿司匹林治疗。该患者接受了成功的重复经皮介入治疗，但后来死于中风并发症。无 30 天事件，且中期随访仍在继续。
心包覆盖支架是一种治疗急性冠状动脉综合征中大量血栓负荷的潜在有用的装置。需要更大规模的研究。
