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中华脑血管病杂志(电子版) ›› 2025, Vol. 19 ›› Issue (02) : 161 -165. doi: 10.3877/cma.j.issn.1673-9248.2025.02.012

病例报告

急性心肌梗死合并颅内出血一例引发的抗血小板治疗思考
马铮1, 江雪1, 张国勇1, 刘佩林1, 郭彩霞1,()   
  1. 1. 100730 首都医科大学附属北京同仁医院心血管内科
  • 收稿日期:2024-07-21 出版日期:2025-04-01
  • 通信作者: 郭彩霞
  • 基金资助:
    北京市高层次公共卫生技术人才-领军人才(领军人才-03-02)

Insights into antiplatelet therapy from a case of acute myocardial infarction complicated with intracranial hemorrhage

Zheng Ma, Xue Jiang, Guoyong Zhang, Peilin Liu, Caixia Guo()   

  • Received:2024-07-21 Published:2025-04-01
  • Corresponding author: Caixia Guo
引用本文:

马铮, 江雪, 张国勇, 刘佩林, 郭彩霞. 急性心肌梗死合并颅内出血一例引发的抗血小板治疗思考[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(02): 161-165.

Zheng Ma, Xue Jiang, Guoyong Zhang, Peilin Liu, Caixia Guo. Insights into antiplatelet therapy from a case of acute myocardial infarction complicated with intracranial hemorrhage[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2025, 19(02): 161-165.

图1 急诊冠脉造影及介入治疗影像。图a 为左冠脉造影,提示左主干末端闭塞;图b 为右冠脉造影,提示右冠脉近段80%局限性狭窄,左室后支中段-远段50%~80%弥漫性狭窄,左室后支近段80%弥漫性狭窄,后降支远段90%节段性狭窄;图c 为导丝通过左主干病变后清晰显示前降支及回旋支近端病变;图d 为左冠脉急诊介入治疗后效果,前降支与回旋支近端支架植入
图2 不同时间颅脑CT 显示患者颅内血肿(箭头所示)。图a 及图b 分别为出血当日颅底及小脑部位血肿;图c 及图d 分别为出血次日颅底及小脑部位血肿;图e 及图f 分别为出血第3 天颅底及小脑部位血肿;图g 及图h 分别为出血第5 天颅底及小脑部位血肿
图3 脑血管CT血管造影显示左侧C5段狭窄<25%,右侧C6段狭窄约50%(图3d箭头所示),右侧椎动脉细小。图a为前后位;图b 为左侧位;图c 为后前位;图d 为右侧位
图4 启用氯吡格雷抗血小板治疗1 周后复查颅脑CT 显示患者颅内血肿体积(箭头所示)持续缩小。图a、b 分别为颅底和小脑部位血肿
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