经导管冠状动脉内溶栓治疗经皮冠状动脉介入术中无复流现象的管理：一项回顾性观察研究。
Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study.
作者信息
Singh Rakendra, Singla Sanjeev Kumar, Singla Ankush, Manchanda Surbhi, Kaur Manjot
机构信息
Department of Medicine, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.
Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.
出版信息
Int J Appl Basic Med Res. 2022 Oct-Dec;12(4):260-264. doi: 10.4103/ijabmr.ijabmr_407_22. Epub 2022 Dec 19.
BACKGROUND
Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden.
AIM
Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI.
MATERIALS AND METHODS AND RESULTS
This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%.
CONCLUSIONS
Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects.
背景
冠状动脉内血栓在ST段抬高型心肌梗死（STEMI）患者中很常见。经皮冠状动脉介入治疗（PCI）是这些患者的首选治疗方法。即使使用双联抗血小板药物、糖蛋白IIb/IIIa抑制剂和抗凝药物，冠状动脉内血栓在STEMI患者的PCI治疗过程中仍然是一个挑战。冠状动脉内血栓可导致远端或非罪犯血管栓塞以及无复流状态。无复流会导致大面积梗死、不良的左心室重构、心律失常和死亡。最近，导管直接冠状动脉内溶栓（ICT）在因血栓负荷大而出现无复流的患者中越来越被接受。
目的
评估导管直接ICT在PCI期间因血栓负荷大而出现无复流的急性STEMI患者中的应用。
材料与方法及结果
这是一项回顾性观察研究，于2021年4月15日至2022年4月14日在印度北部一家三级护理医院经机构伦理委员会批准后进行，纳入了1020例接受冠状动脉评估的成年患者。37.25%的患者接受了PCI，其中10%因急性STEMI接受PCI。心肌梗死溶栓（TIMI）血流分级5级的占79.17%，4级的占20.83%。ICT使用低剂量替奈普酶（15±5mg）进行。冠状动脉内溶栓后，91.67%的患者达到TIMI血流III级，8.33%的患者达到II级。主要危险因素是41.67%的患者吸烟，主要并发症是33.33%的患者出现左心室衰竭。
结论
导管直接ICT在减轻血栓负荷方面安全有效，从而改善STEMI患者的心肌再灌注。这种情况预后严重，可导致不良心脏结局。已经尝试了许多药物来处理无复流。使用ICT治疗无复流状态可挽救生命，且全身副作用最小。
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