Veoma kasna tromboza metalnog stenta devet godina nakon primarne perkutane koronarne intervencije

  • Predrag Aleksandar Djurić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Slobodan Obradović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia, Clinic of Urgent Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Zoran Stajić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
  • Marijan Spasić Clinic of Urgent Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Radomir Matunović Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Radoslav Romanović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia, Clinic of Urgent Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Nemanja Djenić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia, Clinic of Urgent Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Zoran Jovic Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP141222053D
Ključne reči: stents||, ||stentovi, drug-eluting stents||, lekom obloženi, thrombosis||, ||tromboza, myocardial infarction||, ||infarkt miokarda, angioplasty, baloon||, ||angioplastika, balonska,

Sažetak


Uvod. Tromboza stenta (ST) može se klasifikovati u kliničkoj praksi, prema vremenu nastanka, u ranu (0–30 dana nakon implantacije stenta), koju možemo dalje podeliti na akutnu, ukoliko se javi u prva 24 h, subakutnu (1–30 dana), kasnu (> 30 dana) i veoma kasnu (> 12 meseci). Reinfarkt miokarda usled veoma kasne ST kod bolesnika na antiagregacionoj terapiji javlja se veoma retko i može biti smrtonosan. Proceduralni i tehnički faktori su povezani sa akutnom/subakutnom trombozom stenta. S druge strane, neoateroskleroza u području stenta, upala, prerano prekidanje antiagregacione terapije, kao i neadekvatna apozicija stenta igraju važnu ulogu u kasnoj/veoma kasnoj ST. Neka istraživanja pokazala su da je etiologija veoma kasne tromboze metalnog stenta (BMS) u značajnoj meri drugačija od one nakon implantacije stenta obloženog lekom (DES). Prikaz bolesnika. Prikazali smo 56-godišnjeg muškarca sa akutnim inferoposteriornim infarktom miokarda sa elevacijom ST segmenta (STEMI) usled veoma kasne tromboze stenta, 9 godina nakon implantacije BMS, uprkos primeni antiagregacione terapije. Učinjena je uspešna tromboaspiracija, nakon čega je urađena primarna perkutana koronarna intervencija (PKI) sa ugradnjom jednog DES na mestu prethodno implantiranih stentova i tako lečili in-stent restenozu. Zaključak. Veoma kasna tromboza stenta, iako srećom retka i još nedovoljno razjašnjena, može izazvati reinfarkt miokarda, ali se može uspešno lečiti tromboaspiracijom i primarnom PKI. Ruptura plaka neointime sa posledičnom trombozom može biti uzrok veoma kasne tromboze stenta kod prikazanog bolesnika.

Biografija autora

Predrag Aleksandar Djurić, Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
mr sci med, cardiologist

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Objavljeno
2017/03/03
Broj časopisa
Vol. 73 Br. 8 (2016)
Rubrika
Prikaz bolesnika