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目的 :介绍血栓经导管吸引后直接置入支架处理急性心肌梗死 (AMI)并发冠状动脉 (冠脉 )内血栓的急诊介入治疗方法 ,并观察其近期临床疗效。方法 :选择急诊冠脉造影显示梗死相关血管完全闭塞伴冠脉内血栓的AMI患者 ,常规经皮腔内冠脉成形术 (PTCA) ,选用 0 .35 6mm普通冠脉导丝通过病变后 ,经导丝直接送入PercuSurge导管系统中的吸引导管至病变部位 ,持续负压吸引 ,至血栓影消失 ,前向血流恢复后采取直接冠脉内支架置入术 ,观察术前和术后梗死相关血管血流和心肌灌注情况 ,并随访术后近期心功能和主要心血管事件的发生率。结果 :17例患者中经导管吸引后即刻血栓影减少或消失 ,梗死血管直接开通者 15例 (88.3% ) ,其中前向血流恢复达TIMI 3级者 11例 (6 4 .7% ) ,TIMI 2级者 4例 (2 3.5 % ) ;另 2例前向血流未恢复 ,吸引导管不能通过。血栓吸引后再置入支架 ,术后即刻前向血流恢复达TIMI 3级者 14例 (82 .4 % ) ,TIMI 2级者 3例 (17.6 % )。TIMI心肌灌注分级达TMP 3级者 13例 (76 .5 % ) ,TMP 2级者 4例 (2 3.5 % )。未发生与手术相关的并发症。随访住院期间无心绞痛、再梗死及死亡等事件发生。出院前测定左室射血分数为 33%～ 76 % [(6 1.1± 11.3) % ]。结论 :血栓经导管吸引后直接支架术是处理AMI并发?
OBJECTIVE: To introduce the emergency interventional treatment of thrombus directly inserted into the stent after catheterization and to treat acute myocardial infarction (AMI) complicated with coronary thrombus (coronary artery) thrombosis, and to observe its short-term clinical curative effect. Methods: Acute coronary angiography (AMI) was performed to show AMI patients with complete occlusion of infarcts and coronary thrombosis. Conventional percutaneous transluminal coronary angioplasty (PTCA) The guide wire was directly transferred to the PercuSurge catheter system to attract the catheter to the lesion site, and the negative pressure was continuously drawn until the thrombus disappeared. The direct coronary stent was used to recover the anterior blood flow, and the preoperative and postoperative infarction related Vascular flow and myocardial perfusion, and follow-up postoperative cardiac function and the incidence of major cardiovascular events. Results: Thrombosis was reduced or disappeared immediately after catheterization in 17 patients. There were 15 cases (88.3%) with direct inflow of infarcts, and 11 cases (6.67% TIMI grade 2 in 4 cases (23.5%); the other two cases of anterior flow was not restored, the suction catheter can not pass. After the thrombus was taken into the stent, 14 patients (82.4%) had TIMI grade 3 and 3 (17.6%) patients with TIMI grade 2 immediately after blood flow recovery. TIMI myocardial perfusion grade TMP grade 3 in 13 cases (76.5%), TMP 2 grade in 4 cases (23.5%). No surgery-related complications occurred. Follow-up during hospitalization without angina, and then infarction and death occurred. Pre-discharge left ventricular ejection fraction was 33% to 76% [(61.1 ± 11.3)%]. Conclusion: Direct stent thrombosis after catheterization is the treatment of AMI complicated?