药物洗脱支架预防血管成形术再狭窄的机制及潜在问题

Mechanisms and potential problems of drug-eluting stent in preventing restenosis after percutaneous transluminal angioplasty

药物洗脱支架(DES)应用于预防血管成形术后再狭窄是介入治疗领域的革命性变革。在带来可喜成果的同时,问题也在不断涌现,尤其是对血管内皮化的影响、损伤后血管壁的延迟愈合以及迟发性血栓形成等使DES的安全性问题成为当今世界范围内争论的焦点。虽然大量临床研究显示DES可增加晚期血栓形成的风险,但相应的分子生物学机制尚非十分清楚。本文主要针对血管内支架成形术后新生内膜形成、DES抑制再狭窄的分子机制及支架内血栓形成的潜在机制等进行综述。

The introduction of drug-eluting stents in preventing restenosis after percutaneous transluminal angioplasty has revolutionized the field of interventional radiology, especially for cardiovascular intervention. Despite the dramatic early ef- ficacy in reducing restenosis rates, there is growing concern for the safety problems about DES, which is due to the effect on endothelialization, delayed healing and late stent thrombosis after the DES placement. Although several clinical studies raised the possibility of a substantially higher risk of stent thrombosis in DES, evidence remains inconclusive. This review focused on the pathophysiological mechanisms and pathological findings about the neointimal hyperplasia, restenosis pre- vention and stent thrombosis in DES.