药物涂层球囊概述及其在外周动脉疾病治疗中的应用进展

Progress of Drug Coated Balloon and Its Application in the Treatment of Peripheral Arterial Disease

经皮经腔血管成形术(PTA)已广泛用于外周动脉疾病(PAD)的治疗。然而,该技术存在血管壁弹性回缩和内膜增生等不足。PTA术后植入金属裸支架(BMS)虽然可以减少血管壁弹性回缩,但由此引起的支架内再狭窄(ISR)又成为治疗中的一个突出问题。药物洗脱支架(DES)被用来解决狭窄问题,但晚期支架内血栓形成(LST)、内皮化延迟和必须长期抗血小板治疗等问题也随之而来。在这样的背景下,药物涂层球囊(DCB)获得了快速发展。DCB作为非支架方案,可将所携载的活性药物转移至病变段血管壁,对ISR或原发病变均有较好的治疗效果。本文简要介绍了DCB的发展历史,并通过实验室研究、动物实验和临床试验,从机制上阐述涂层技术、涂层药物、赋形剂等对DCB功效和安全性的影响以及DCB在PAD治疗中的应用进展。

Percutaneous transluminal angioplasty （PTA） has been widely used in the treatment of peripheral arterial disease （PAD）. However, there are some shortcomings in this technique, such as elastic recoil of the vessel wall and neointimal hyperplasia. Implantation with bare metal stent （BMS） after PTA can reduce the elastic recoil of the vessel wall, but in stent restenosis （ISR） has also become a prominent problem in the treatment. Drug eluting stents （DES） are used to resolve the problem oflSR, but late stent thrombosis （LST）, delayed endothelialization, and long-term antiplatelet therapy are also associated with the treatment of DES. In this context, the drug coated balloon （DCB） has gained rapid development. As a non stent based treatment perscription, the DCB angioplasty can transfer the active drugs to the vascular wall of the diseased section, and have better therapeutic effects on ISR or de novo lesions. This paper briefly introduces the development history of DCB, and through laboratory research, animal experiments and clinical trials, to expound the coating technology, coating drugs, excipients and so on DCB efficacy and safety from the mechanism, and its application progress in the treatment of PAD.