药物洗脱支架临床应用安全性的影响因素

Factors influencing clinical safety of drug-eluting stent

目的:介绍药物洗脱支架在临床应用中的相关问题,从支架本身、涂层物质以及生物活性成分进行分析,探讨药物洗脱支架在临床应用中的安全性和有效性。方法:以"药物洗脱支架,金属裸支架,血管再狭窄"为中文关键词;以"Drug-eluting stent,Bare metal stent,Restenosis"为英文关键词,采用计算机检索1990-01/2008-10相关文章。纳入与药物洗脱支架与裸支架临床应用的安全性比较研究相关文章;排除重复研究或Meta分析类文章。以17篇文献为主重点探讨药物洗脱支架在临床应用中的安全性和有效性。结果:目前临床上所用的药物洗脱支架均存在值得进一步改进的可能,未来药物洗脱支架的发展方向是研发适合小血管、分叉部位的支架和扩展PCI适应证;寻求新的涂层、生物材料支架;研发支架药物的选择和洗脱技术,以及在维持DES作用、改善安全性的同时,寻找促进支架植入部位血管内膜愈合的方法。结论:改良支架平台及研发新型支架仍将是热点,注重远期疗效成为药物洗脱支架发展趋势。

OBJECTIVE：To introduce clinical application of drug-eluting stent,and explore the safety and efficacy by analyzing stent,eluting material,and bioactive components.METHODS：With key words ＂drug-eluting stent,bare metal stent,restenosis＂ in Chinese and English,a computer-based online search was performed for articles published between January 1990 and October 2008.Articles related to comparison of safety between drug-eluting stent and bare metal stent were included.Repetitive studies or Meta analysis were excluded.Finally,17 articles were selected,which discussed safety and efficacy of drug-eluting stent in clinical application.RESULTS：Currently used drug-eluting stent can be further improved to fit small vessels,furcation site and expanded PCI indications.Moreover,new coating and biomaterials,drug selection and eluting technique,methods to improve tunica intima healing at implant site are important.CONCLUSION：Modification of stent platform and development of novel stent become study hot spot.Long-term effect is significant for application of drug-eluting stent.