Iwasaki Masamichi, Sawada Takahiro, Shinke Toshiro, Okamoto Hiroshi, Kim Su-Sik, Shite Junya, Hirata Ken-Ichi, Yokoyama Mitsuhiro
Hyogo Prefectural Awaji Hospital, 1-6-6 Shimogamo, Sumoto, Hyogo 656-0013, Japan.
Kobe University Graduate School of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan.
J Cardiol Cases. 2011 Mar 16;3(3):e123-e128. doi: 10.1016/j.jccase.2011.02.003. eCollection 2011 Jun.
A drug-eluting stent was implanted at the culprit lesion in a 65-year-old man with acute coronary syndrome. Nine days after the procedure, he suffered stent thrombosis, and a bare-metal stent was subsequently implanted. Twelve days after this second procedure, a follow-up angiogram showed a newly emerged thrombus at the site of stent implantation. Although the patient had continued dual anti-platelet therapy with aspirin and clopidogrel since the first procedure, platelet optical aggregation test showed no inhibition of aggregation. Further, genetic analysis revealed him to be homozygous for the CYP2C192 polymorphism. This case suggests that the mechanism of stent thrombosis, while multi-factorial, is affected greatly by crossover of poor responsiveness to clopidogrel due to the CYP2C192 polymorphism.
一名65岁的急性冠状动脉综合征男性患者在罪犯病变处植入了药物洗脱支架。术后九天，他发生了支架内血栓形成，随后植入了裸金属支架。第二次手术后12天，随访血管造影显示在支架植入部位出现了新的血栓。尽管自第一次手术后患者一直继续使用阿司匹林和氯吡格雷进行双联抗血小板治疗，但血小板光学聚集试验显示聚集未受抑制。此外，基因分析显示他为CYP2C192多态性纯合子。该病例表明，支架内血栓形成的机制虽然是多因素的，但由于CYP2C192多态性导致对氯吡格雷反应性差的交叉影响很大。
