Analysis of the factors and treatment of the acute and subacute thrombosis in the coronary drug-eluting stent

doi:10.3969/j.issn.1002-1949.2014.04.009

Abstract：Objective To analyze the Factors and treatment of the acute and subacute thrombosis in the coronary drug -eluting stent ( DES ) and to evaluate the efficacy of the emergent percutaneous coronary intervention (PCI)for it.Methods baseline and follow-up data of 5320 patients who underwent PCI and implanted DES in our hospital from December 2007 to December 2012 , in which 43 patients suffered from acute and subacute thrombosis Results ①43 acute and subacute coronary in-stent thrombosis was confirmed in 5320 patients ( 0.81%) and 9 patients died ( mortality 20.93%).The thrombosis occurred from 6 hours to 11 days after PCI (4.2 ±4.6)d.②Target vessel of the thrombosis:33 in the left anterior descending artery (LAD), 3 in the left cicumlex artery(LCX) and 7 in the right coronary artery ( RCA);The lesions type:39 cases were type B/C and 4 cases were type A;Artery diameter of thrombosis:19 in 2.5 mm,22 in 3.0 mm and 3 in 3.5 mm artery respectively;The length and the number of the stents in the target vessel:38 were more than 2 stents (2.87 ±0.40) mm ×(32.39 ±7.72) mm and 5 were only one stent (3.18 ±0.39) mm ×(19.87 ±4.66) mm.③Among the 43 cases, 19 caused by stent malapposition , 14 by small vessel and long lesion , 5 by endothelial tear of overdistension and 3 by clopidogre resistant .④35 patients were treated by high pressure balloon dilatation and 5 patients were treated by planting more stent .Conclusion The risk factors of developing in -stent thrombosis were lesion type , intervention operating factors , the length and diameter of the stents and clopidogre resistant . It occurred higher in patients with diabetes , hypertension ,multi-vessel disease , target lesion in LAD and suffuse lesion .Emergency PCI are the most effective methods for treating acute and subacute thrombosis .