斑块破裂后血栓形成.pdfVIP

Images in Cardiovascular Medicine Residual Thrombogenic Substrate After Rupture of a Lipid-Rich Plaque Possible Mechanism of Acute Stent Thrombosis? A Near-Infrared Spectroscopy Study Rahul Sakhuja, MD, MPP, MSc; William M. Suh, MD; Farouc A. Jaffer, MD, PhD; Ik-Kyung Jang, MD, PhD 63-year-old man with hypertension and hyperlipidemia Apresented to the emergency department with an infero- posterior ST-segment elevation myocardial infarction. The patient was treated with aspirin 325 mg, clopidogrel 600 mg, and intravenous heparin and was transferred for primary percutaneous coronary intervention. The coronary angiogram revealed an occluded proximal right coronary artery. Heparin was switched to bivalirudin. Aspiration thrombectomy re- trieved white thrombus and established TIMI (Thrombolysis In Myocardial Infarction) grade 3 flow (Figure 1A). A 3.523-mm bare-metal stent was placed (Figure 1B), which was postdilated to 4.0 mm. There was no angiographic evidence of dissection or filling defect (Figure 1C) with resolution of ST-segment changes on ECG. Bivalirudin was stopped at the end of the procedure, and the patient was transferred to the cardiac intensive care unit. Eight hours later, the patient developed recurrent chest pain with re-elevation of the ST-segment changes on ECG. An emergent coronary angiogram revealed thrombotic occlusion at the proximal edge of the stent (Figure 1D). Aspiration thrombectomy retrieved a large amount of thrombotic mate- rial, with restoration of TIMI grade 3 flow (Figure 1D, inset). Figure 1. Angiographic frames of the right coronary artery in the Intravascular ultrasound reveal