股腘动脉支架内血栓形成的原因及围手术期的药物治疗.docVIP

精品论文 参考文献 股腘动脉支架内血栓形成的原因及围手术期的药物治疗 万国顺 沈焕（沈阳医学院沈洲医院血管外科 110002） 【中图分类号】R969 【文献标识码】A【文章编号】1672-5085（2013）14-0137-03 【摘要】 目的 探讨股腘动脉支架术后急性血栓形成的原因。方法 分析2例股腘动脉支架术后反复形成血栓的病例的治疗过程和用药方法。结果 病例1的血栓形成可能与：1.在原有血管内膜炎（本病例为血栓闭塞性脉管炎）的基础上，支架金属的刺激导致动脉炎症和痉挛增加(强化他汀类药物和解痉治疗更为重要)；2.可能存在阿斯匹林和氯吡格雷抵抗？加用替罗非班后三联抗血小板效果良好；3.较小的最终管腔内径（支架扩张不良或支架贴壁不良）；4.支架的支撑性和柔顺性：由于病变位于膝关节，选择支架时过多考虑支架的柔顺性，可能导致选择支架的支撑性降低，使支架的长轴变形，引起支架压缩。病例2的血栓形成可能与:1.病变段支架覆盖不全；2.较小的最终管腔内径；3.病人应用药物依从性差。结论 病变段支架覆盖不全，支架金属的刺激导致动脉炎症和痉挛增加，阿斯匹林和氯吡格雷抵抗，较小的最终管腔内径（支架扩张不良或支架贴壁不良），选择支架时过多考虑支架的柔顺性，可能导致选择支架的支撑性降低，使支架的长轴变形，引起支架压缩，病人应用药物依从性差等因素可能导致股腘动脉支架术后急性血栓形成。 【Abstract】Objective: Discuss the causes of the acute thrombosis after the femoral artery stent implantation. Method: Analysis the course of treatments and methods for the two cases of acute thrombosis after the femoral artery stent implantation. Results: The possible cause of thrombosis for the case 1 is: 1) On the basis of endoangiitis, the stimulation of metal stent placement causes the artery inflammation and the increasing spasm. (Itrsquo;s more important to use the statin and spasmolysant treatment.) 2) There maybe has the resistance of aspirin and clopidogrel. It has much better effect after adding the tirofiban. 3) The inner diameter of blood vessel is too small (The stent wasnrsquo;t expandable very well or malapposition). 4) The tenability and flexibility of stent may influence the effects. Because the lesion is located at the knee joint, if we focus on the stentrsquo;s flexibility too much, it may lead to reduce the tenability, deform long axis of stent and finally compress the stent. The possible cause of thrombosis for the case 2 is: 1) The lesion area is not covered fully with stent. 2) The inner diameter of blood vessel is too small. 3) The patient has a poor compliance for the treatment. Conclusion: The reasons such as none covered wholly with stent in the lesion area, artery inflammation and spasm increasing resulted from stimulation of metal stent placement, the