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PCI后即刻给予经导管放射治疗增加支架内血栓形
主要研究者德国柏林自由大学的Rauch等人指出，β及γ射线可用于预防PCI后支架内再狭窄复发。但是PCI术后即刻给予血管内放射治疗增加支架内血栓形成的危险。
为了确定引起上述不良反应的原因，Rauch等人对50例稳定型心绞痛患者成功介入治疗后给予放射治疗预防支架内再狭窄。23例患者采用β射线治疗，术前３～４周开始预防性使用阿司匹林及氯匹格雷。对照组27例患者没有预先给予阿司匹林及氯匹格雷进行预处理。放射治疗组患者治疗后即刻血小板激活指标显著升高。血小板反应素阳性的血小板比例由12.7％增加至21.2％，CD63阳性血小板由37.9％增加至54.0％，P＜0.01。PCI术后即刻没有接受放射治疗的患者在围手术期间血小板激活无显著差异。
为观察血小板激活是否与放射治疗本身有关，Rauch等人将健康人的血液样本暴露于比治疗量高８倍的放射线。结果与未暴露放射线的血液样本比较，血小板激活指标也没有升高。
研究者指出，血小板激活可能受放射治疗源长度（与内皮损伤有关）及高度致栓性的导管在体内停留的时间影响。
以上内容摘至中国医学论坛报第899期。
原文见Catheter based intracoronary brachytherapy leads to increased platelet activation.Heart,2004,Feb;90(2):160-4.现附摘要：
Jaster M, Fuster V, Rosenthal P, Pauschinger M, Tran QV, Janssen D, Hinkelbein W, Schwimmbeck P, Schultheiss HP, Rauch U.
Department of Cardiology, University Hospital Benjamin Franklin, Free University of Berlin, Berlin, Germany.
BACKGROUND: Vascular brachytherapy (VBT) after percutaneous coronary intervention (PCI) is associated with a higher risk of stent thrombosis than conventional treatment. OBJECTIVE: To investigate in vivo periprocedural platelet activation with and without VBT, and to assess a possible direct effect of radiation on platelet activation. DESIGN: Of 50 patients with stable angina, 23 received VBT after PCI, while 27 had PCI only. The 23 patients who received VBT after PCI were pretreated for one month with aspirin and clopidogrel. Platelet activation was assessed by flow cytometry. RESULTS: The two patient groups did not differ in their platelet activation before the intervention. There was a significant increase in activation immediately after VBT, with 21.2% (interquartile range 13.0% to 37.6%) thrombospondin positive and 54.0% (42.3% to 63.6%) CD 63 positive platelets compared with 12.7% (9.8% to 14.9%) thrombospondin positive and 37.9% (33.2% to 45.2%) CD 63 positive platelets before the intervention (p < 0.001 and p < 0.01, respectively). Patients without VBT had no periprocedural difference in platelet activation immediately after PCI. No increase in platelet activation was found after ex vivo irradiation of blood samples obtained from healthy controls. CONCLUSIONS: Catheter based intracoronary VBT carried out according to current standards is highly thrombogenic. The current antithrombotic treatment with aspirin and clopidogrel is not sufficient to suppress platelet activation during the procedure. From in vitro experiments, it appears that platelet activation during brachytherapy is not caused by irradiation but by the procedure of catheter based VBT.
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作者:admin@医学,生命科学 2011-07-09 17:14
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