在透析患者心肌梗塞后扩大LV伪动脉瘤的战略DAPT中断
Takeyoshi Kameyama1, Yuki Kurose1, Minoru Yambe1
1Faculty of Medicine, Division of Cardiovascular Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
JACC. Case reports
|March 16, 2026
概括
在高风险患者中,左心室伪动脉瘤的管理可能具有挑战性. 随着战略双抗血小板治疗中断的保守观察,在一个病例中导致了完全的血栓形成和吸收.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心血管医学 心血管医学
背景情况:
- 心肌梗塞 (MI) 后的左心室伪动脉瘤 (LVPA) 具有很高的破裂风险,通常需要手术修复.
- 患有重大并发症的患者往往会带来不可避免的外科手术风险.
研究的目的:
- 描述左心室伪动脉瘤的保守管理在一个患有禁止手术风险的病人.
- 评估战略双抗血小板治疗中断在管理LVPA进展中的有效性.
主要方法:
- 一名血液透析患者患有ST升高MI,接受了穿皮冠状动脉干预.
- 心声图显示了LVPA逐渐扩大.
- 由于手术风险很高,开始了战略双抗血小板治疗中断的保守管理.
主要成果:
- 在12天的时间里,LVPA扩大了约30%.
- 在治疗中断14天内发生了LVPA的完全血栓形成.
- 在21个月的随访期内,LVPA显示完全吸收.
结论:
- 虽然保守的管理与密集监测是高风险患者中小LVPA的选择,但快速扩大需要考虑干预.
- 经过多学科的共识,在双重抗血小板治疗的战略性中断可能是选择高风险个体的LVPA管理的可行选择.
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