我认为对于分叉病变患者不需要延长双联抗血小板治疗的疗程,因为我们已经取得了令人满意的最佳结果。必须指出新一代支架尤其是使用了生物可吸收聚合物的支架,已经显示了比第一代支架更低的血栓形成发生率。
Antonio Colombo教授:Colombo博士是意大利米兰哥伦布医院心脏导管室主任,兼任San Raffaele医院介入心脏病科主任。目前Colombo博士是哥伦比亚大学医学院的访问教授。
International Circulation: Stent thrombosis is an important risk factor for ischemic events after DES implantation, and this happens more frequently in complex bifurcation lesions. Do you think it is necessary to prolong duration of dual antiplatelet therapy in these types of lesions?
Dr Colombo: I do not believe that we need to prolong the duration of dual antiplatelet therapy in bifurcation lesions provided that we are happy about the optimum result that we have achieved. It is important to note that new generation stents especially those with bioabsorbable polymer, have shown overall a lower rate of thrombosis compared to the first generation stents. We also know that in bifurcations treated with one stent or two stents, provided the operator is confident that the result is optimal, there is really no increase in stent thrombosis even with first generation stents. So I believe if you put these two variables together – optimal result and second generation stents – I do not see any reason to increase the duration of dual antiplatelet therapy.
《国际循环》:支架内血栓形成是DES置入术后发生缺血事件的重要危险因素之一,多发生于复杂的分叉病变。您是否认为对这类病变有必要延长患者的双联抗血小板疗程?
Dr Colombo:我认为对于分叉病变患者不需要延长双联抗血小板治疗的疗程,因为我们已经取得了令人满意的最佳结果。必须指出新一代支架尤其是使用了生物可吸收聚合物的支架,已经显示了比第一代支架更低的血栓形成发生率。此外,对于置入了1枚或2枚支架的分叉病变,在手术者对手术操作取得最佳结果已有足够自信的前提下,即使是使用了第一代支架,支架内血栓形成的发生率也的确没有增加。因此我相信,如果你已将2个因素合二为一——最佳的结果和第二代支架——我实在没有任何理由去延长双联抗血小板治疗的疗程。