取栓持续溶栓治疗支架内血栓形成及文献分析

The Clinical Application of Percutaneous Mechanical Thrombectomy and Continuous Contact Thrombolysis in Acute In-Stent Thrombosis as Well as Literature Review

摘要: 目的：探索颈内动脉支架置入术后急性支架内血栓形成的治疗方法。方法：回顾性分析1例急性脑梗死患者颈内动脉支架置入术后急性支架内血栓形成经机械取栓后续持续接触性溶栓治疗经过并复习相关文献。结果：急性脑梗死患者处于高凝状态、未经充分抗血小板或抗凝治疗者经颈内动脉支架置入术后易形成急性支架内血栓，经机械取栓后联合持续接触性溶栓治疗及其他措施可促使血管再通，加速恢复。相关文献显示颈内动脉支架置入术后急性支架内血栓形成经及时恰当的治疗多数能获得良好疗效。结论：高凝状态及抗血小板、抗凝治疗不充分是颈内动脉支架置入术后急性支架内血栓形成的重要原因，及时恰当的血管再通措施是关键，机械取栓联合持续接触性溶栓治疗是促使血管再通的有效方法，值得进一步探索。

Abstract: Objective: To explore the treatment of Acute in-stent thrombosis (AIST) after Carotid artery stenting (CAS). Methods: The characteristics of 1 cases of acute ischemic stroke (AIS) presented with AIST after emergency left internal CAS which was successfully treated with the percutaneous mechanical thrombectomy (PMT) following continuous contact thrombolysis (CCT) technique were discussed with review of literatures. Results: The patients with AIS were in hypercoagulable state. AIST could occur after CAS without adequate antiplatelet or anticoagulant therapy. PMT combined with CCT could maintain revascularization and accelerate the recovery. Related literature shows that AIST occurs after CAS, but most can achieve good results by timely and appropriate treatment. Conclusion: Hypercoagulable state and inadequate antiplatelet as well as anticoagulant therapy is the main causes of AIST after emergency CAS. Timely and appropriate treatment after AIST is the key to reduce disability and promote the recovery of neurological function. PMT combined with CCT are effective methods for revascularization and worthy of further exploration.