Stalder Gregoire, Chatte Antoine, De Rossi Noemy, Yerly Patrick, Alberio Lorenzo, Eeckhout Eric
Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
Service of Hematology and Laboratory of Hematology, Institut Central des Hôpitaux, Hôpital du Valais, Av. du Grand-Champsec 86, CH-1951 Sion, Switzerland.
Eur Heart J Case Rep. 2023 Jan 18;7(2):ytac497. doi: 10.1093/ehjcr/ytac497. eCollection 2023 Feb.
Acute and subacute stent thromboses are a rare complication associated with high mortality and morbidity occurring in ∼1.5% of patients treated with primary percutaneous intervention for ST-elevation myocardial infarction (STEMI). Recent publications describe a potential role of the von Willebrand factor (VWF) in thrombus formation at sites of critical coronary stenosis in STEMI.
We describe a 58-year-old woman with STEMI at initial presentation, who suffered subacute stent thrombosis despite good stent expansion, efficacious dual antiplatelet therapy, and therapeutic anticoagulation. Because of very high VWF values, we administered -acetylcysteine in order to depolymerize VWF, but the drug was not well tolerated. Since the patient was still symptomatic, we used caplacizumab in order to prevent VWF from interacting with platelets. Under this treatment, the clinical and angiographic course was favourable.
Considering a modern view of intracoronary thrombus pathophysiology, we describe an innovative treatment approach, which eventually ended in a favourable outcome.
急性和亚急性支架血栓形成是一种罕见的并发症，与高死亡率和高发病率相关，在接受ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗的患者中发生率约为1.5%。最近的出版物描述了血管性血友病因子（VWF）在STEMI患者严重冠状动脉狭窄部位血栓形成中的潜在作用。
我们描述了一名初诊为STEMI的58岁女性，尽管支架扩张良好、双联抗血小板治疗有效且进行了抗凝治疗，但仍发生了亚急性支架血栓形成。由于VWF值非常高，我们给予了N-乙酰半胱氨酸以解聚VWF，但该药物耐受性不佳。由于患者仍有症状，我们使用了卡泊珠单抗以防止VWF与血小板相互作用。在这种治疗下，临床和血管造影过程良好。
考虑到冠状动脉内血栓病理生理学的现代观点，我们描述了一种创新的治疗方法，最终取得了良好的结果。
