International Circulation: How do you approach the prevention of thrombosis in patients with drug-eluting stents?
国际循环：请问您是如何预防药物涂层支架血栓形成的？

Prof. Bruce Brodie: We try not to put them in non-compliant patients， trying only to put them in patients who will be compliant and take their chlopidogrel and aspirin.  For patients with drug-eluting stents put in for stemi patients， they should be on chlopidogrel for beyond one year.  That is one sub-group with an incidence of stent thrombosis that appears to be high for the long-term so they should be on chlopidogrel long-term.  Maybe some of the new drugs， such prazogrel， may be indicated in this group because there is no question that stemi patients have a much higher incidence of stent thrombosis than elective PCI. 
Prof. Bruce Brodie: 我们尽量对依从性差的患者不予以植入药物涂层支架，对依从性好、能坚持服用阿司匹林和氯吡格雷的患者植入药物涂层支架。ST段抬高性心梗患者植入药物涂层支架后，至少服用氯吡格雷一年。有一亚组分析显示，随着时间的推移，支架内血栓的发生率增高，所以需要长期服用氯吡格雷。也许一些新的药物例如普拉格雷（prasugrel)可能适用于这组患者，因为毫无疑问与择期PCI相比，急性ST段抬高性心梗患者支架内血栓的发生率要高得多。

International Circulation: What is your advice regarding management strategies for patients with stent thrombosis?
国际循环：您对支架内的血栓患者有何治疗建议？

Prof. Bruce Brodie: Many times patients with post-PCI stent thrombosis will present with sudden death and there is nothing that can be done in that situation.  Most of them will present as acute infarction， frequently stemi.  In fact， we have a presentation later this week with ST-elevation myocardial infarction due to stent thrombosis， which is becoming an increasing proportion of our stemi patients that we treat.  When we treat that we generally try to remove the thrombus， using a lot of aspiration catheter to remove the thrombus.  We often use glycoprotein 2A inhibitors and we are starting to give that intracoronarily.  We also always use IVUS to our patients with stent thrombosis to see if the stent was fully deployed.  If we find the stent was under-deployed and that was one of the precipitating factors for thrombosis we will often perform IVUS on these patients and expand the stent appropriately to the vessel size. 
Prof. Bruce Brodie: 很多时候，PCI术后出现支架血栓形成的患者会猝死，在这种情况下我们无能为力。大部分患者表现为急性心肌梗死。我们会在本周进行有关于支架内血栓形成的ST段抬高心肌梗死患者的讲座，这部分患者在我们治疗的心梗患者中所占比例越来越大。对于支架内血栓形成，我们通常使用导管内抽吸术来清除血栓。我们经常使用糖蛋白2A抑制剂溶解血栓，并且尝试冠脉内给药。我们也给支架内血栓形成的患者做血管内超声，看看支架是否释放良好。如果发现支架释放不充分，而这正是支架内血栓形成的重要诱因，我们往往对这类病人在血管内<