颅内外动脉狭窄支架置入后的再狭窄因素分析

Factors for restenosis following stent-assisted angioplasty of intracranial and extracranial arteries

颅内外动脉狭窄支架术后再狭窄是一个极其复杂的病理生理学过程,认识与其相关的因素,对于指导临床治疗和降低再狭窄率有重要意义。血管支架作为一种异物,置入后使血小板激活和聚集并分泌大量细胞因子导致血栓的形成,大量的白细胞在血管损伤部位聚集,分泌出细胞因子,并发生炎症反应,平滑肌细胞向损伤部位迁移发生增殖反应,导致新生内膜增生,血管壁重构引起支架内再狭窄。血管支架置入后发生再狭窄的影响因素还与支架的种类和相关药物支持治疗相关。应用具有抗炎症反应、抗血管平滑肌细胞增生的药物支架,减少机体炎症反应的强度和持续时间,加强术后的药物支持治疗可降低血管内再狭窄的发生率。

Stent-assisted angioplasty of intracranial and extracranial arteries is a complex pathophysiologic process. Therefore, understanding of related factors is significant for guiding clinical treatment and reducing restenosis rate. Intravascular stent as a foreign body leads to platelet activation and aggregation, cytokine secretion, resulting in thrombosis and leukocyte aggregation at vessel injury site to produce cytokine and inflammatory reaction. In addition, the smooth muscle cells migrate to injury site and proliferate, leading to intimal hyperplasia, vessel wall reconstruction and intra-stent restenosis. Moreover, the restenosis following stenting is related to stent type and medicine supportive treatment. Drug-eluted stent with anti-inflammation and vascular smooth muscle cell proliferation can reduce body inflammation intensity and duration, and postoperative medicine supportive treatment can reduce incidence of intravascular restenosis.