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Vojnosanitetski pregled
2016, vol. 73, br. 8, str. 774-778
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.2298/VSP141222053D

Creative Commons License 4.0
Veoma kasna tromboza metalnog stenta devet godina nakon primarne perkutane koronarne intervencije
aClinic of Cardiology, Military Medical Academy, Belgrade + Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade
bFaculty of Medicine of the Military Medical Academy, University of Defence, Belgrade + Clinic of Urgent Internal Medicine, Military Medical Academy, Belgrade
cClinic of Cardiology, Military Medical Academy, Belgrade
dClinic of Urgent Internal Medicine, Military Medical Academy, Belgrade

e-adresa: predrag.a.djuric@gmail.com

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 instent 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.

Ključne reči

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