冠状动脉支架内再狭窄的病理生理及治疗策略

In-Stent Restenosis: Pathophysiology and Treatment

冠状动脉支架内再狭窄严重影响冠心病支架置入患者预后,也是当前经皮冠状动脉介入术治疗领域亟待解决的问题。金属裸支架和药物洗脱支架置入术后支架内再狭窄的管理已经成为临床治疗的一种挑战。尸体解剖和血管内成像为支架内再狭窄的病理生理学研究提供了更多的可能。支架内再狭窄基本的治疗策略包括:球囊血管成形术、斑块切除术、血管内放疗、金属裸支架置入、药物涂层球囊、药物洗脱支架置入。最有效的治疗方法取决于患者和病变特点,药物洗脱支架和药物涂层球囊的问世成为冠心病介入治疗(经皮冠状动脉介入术)技术突破的历史性转折点。现主要讨论支架内再狭窄的病理生理、危险因素及治疗策略。

In-steut restenosis（ISR） seriously affects the prognosis of patients and is also an urgent problem urgently that is necessary to be solved in percutaneous coronary intervention therapy. Management of ISR remains a clinical challenge after both bare-metal stent and drug-eluting stent placement. Autopsy studies and intravascular imaging have augmented our understanding of the pathophysiology of ISR. Potential treatment strategies includes plain old balloon angioplasty, rotational atherectomy, vascular brachytherapy, bare-metal stem, drug-coated balloon, and drug-eluting stent placement. The most efficacious therapy depends on patient and lesion characteristics, but drug-eluting stent and drug-coated balloon yield the most successful angiographic and clinical results. Here, we discuss the underlying pathology, risk factors and treatment of ISR.