药物洗脱支架与晚期、极晚期支架血栓

Late and Very Late Stent Thrombosis of Drug-Eluting Stent

第一代药物洗脱支架在显著降低再狭窄率的同时,也带来了支架血栓尤其是晚期、极晚期支架血栓这一棘手问题。晚期、极晚期支架血栓虽然发生率较低,但一旦发生往往带来灾难性后果。晚期、极晚期支架血栓的发生机制包括血管再内皮化延迟、多聚物过敏反应、支架晚期贴壁不良及新生动脉粥样硬化斑块破裂等。第二代和第三代药物洗脱支架在安全性上可能优于第一代。生物全降解支架代表了药物洗脱支架的发展方向,有望从根本上解决药物洗脱支架的晚期和极晚期支架血栓问题。现对近年来药物洗脱支架晚期及极晚期支架血栓的发生机制及新一代药物洗脱支架的研究进展做一综述。

The first generation of drug-eluting stent significantly reduces the rate of restenosis, and it also has a thorny issue in stent thmmbosls, especially late and very late stent thrombosis. The rate of late and very late stent thrombosis is low, but the event often has disas- trous consequences. The mechanism of late and very late stent thrombosis includes delayed reendothelialization, hypersensitivity reactions to polymer, late stent malapposition, rupture of neoatherosclerosis, etc. The security of the second and the third generation drug-eluting stent may be better than the first. The biodegradable stent represents the direction of development, and it is expected to be a fundamental solution to the late and very late stent thrombosis. In this review, we describe the mechanism of late and very late stent thrombosis and the research progress of the new generation drug eluting stent in recent years.