症状性颅内脑动脉狭窄支架置入后再狭窄:宿主与异物生物相容性中的若干影响因素

Intracranial arterial restenosis after stenting: Influential factors for biocompatibility between host and foreign bodies

颅内动脉狭窄的病因是多方面的,血管支架作为一种异物,置入后刺激血小板在血管支架表面的聚集和激活血小板系统及凝血系统功能,分泌大量细胞因子导致血栓的形成,然后有大量的白细胞将在血管损伤部位聚集,分泌出细胞因子对治愈的组织产生影响,接着发生炎症反应,平滑肌细胞大量向损伤部位迁移发生增殖反应,导致新生内膜的大量增生,血管壁重构引起支架内再狭窄。血管支架置入后发生支架内再狭窄的影响因素不仅有支架种类的因素,如:药物支架再狭窄的发生率低于裸金属支架,而且宿主原有疾病对再狭窄的发生也有影响,血管支架置入前狭窄的严重程度以及支架置入后残留狭窄的长度等都会对再狭窄产生影响。因此,在选择病例时,对>10mm的病变要谨慎,积极治疗宿主的原发疾病,血管置入的支架选择药物洗脱支架等综合手段可以降低再狭窄的发生率。

There are many factors for intracranial arterial stenosis. Vascular stenting as a foreign body can stimulate platelet aggregation on the surface of the stent and activate platelet system and coagulation system to secret plenty of cell factor leading to thrombus, and allowing many white blood cell aggregation at injured vessels to secret cell factors that can influence injury healing. The inflammatory reactions occur followed by migration and proliferation of smooth muscle cells to injured site, resulting in intimal hyperplasia and restenosis due to vessel wall reconstruction. Stent type is one of determiners for restenosis after stenting, for example the incidence of restenosis after drug-eluting stenting is lower than bare metal stenting. In addition, original disease of host can also influence restenosis. The severity of stenosis before stenting and the length of remnant stenosis after stenting are possible factors for restenosis. Therefore, we should be cautious for patients with pathological changes 〉 10 mm, and treat the primary disease in host. Drug-eluting stent is beneficial to reduce incidence of restenosis.