脑血管置入材料的生物相容性及并发症

Biocompatibility and complications of cerebrovascular stents

背景:虽然支架置入技术的发展为脑血管疾病提供了较为有效的治疗手段,但其安全性和有效性还有待进一步验证。目的:阐述脑血管支架与宿主间的生物相容性,分析支架置入并发症的原因,并探讨管理方法。方法:以"脑血管病,支架,生物相容性,并发症"和"Cerebrovascular disease,stents,biocompatibility,complication"为检索词,计算机检索中国期刊全文数据库、PubMed数据库(1993-01/2010-11)与脑血管支架生物相容性、支架置入治疗并发症相关的文章,按纳入和排除标准对文献进行筛选,重点对18篇文章进行分析讨论。结果与结论:脑血管支架临床应用较多的是颅内支架,由于血管的管径限制支架的直径,不同病变对支架直径的要求不同。支架置入并发症主要有腹膜后血肿,颈动脉窦反应,高灌注综合征,脑血管痉挛和血栓形成。在各种脑血管支架中,金属支架生物相容性较差,聚合物支架、涂层支架和药物支架生物相容性均好于金属支架,能有效的预防支架置入后的再狭窄。治疗过程中进行充足的置入前准备,选择合适的支架类型,严格遵循适应证,支架置入中仔细观察病情变化,置入后良好的监测和管理可预防并发症的发生。

BACKGROUND： Although stent implanting technology has provided more effective treatments for cerebrovascular diseases, its safety and effectiveness require to be further verified. OBJECTIVE： To explain the biocompatibility between cerebrovascular stents and the hosts, to analyze the cause of stent complications, and to discuss managements. METHODS： A computer-based online retrieval of China Academic Journal Fulltext Database and PubMed database between January 1993 and November 2010, with the Keywords of ＂cerebrovascular disease, stents, biocompatibility, complications＂ in Chinese and English. Studies regarding the biocompatibility of cerebrovascular stents and the complications of stent implantation were included, according to inclusion and exclusion criteria, 18 articles were mainly discussed. RESULTS AND CONCLUSION： Intracranial stent is a commonly used cerebrovascular stent is clinical application. Because the vascular diameter affects the stent diameter, different diseases require different diameters of the stent. Stent complications include retroperitoneal hematoma, carotid sinus response, hyperperfusion syndrome, cerebral vasospasm and thrombosis. Among a variety of cerebrovascular stents, metal stents have the poor biocompatibility, while polymer stents, coating stents and drug stents have a better stent biocompatibility than metal stents, which can effectively prevent restenosis after stent implantation. Adequate preparation is necessary before implantation, such as the selection of the appropriate stent type, strictly according the indications, careful observation in stent placement, close monitoring and management after implantation, thus preventing complications.