支架内新生动脉粥样硬化的研究进展

Research Progress of In-stent Neoatherosclerosis

支架内再狭窄(in-stent restenosis,ISR)和支架内血栓(in-stent thrombosis,IST)是目前经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的两大主要并发症,也是阻塞性冠脉病变介入治疗的主要限制因素。支架内新生动脉粥样硬化(in-stent neoatherosclerosis,ISNA)是ISR和IST共同的病理基础,目前研究主要基于光学干涉断层显像(optical coherence tomography,OCT)、血管镜、血管内超声(intravascular ultrasonography,IVUS)等临床影像学观察及尸检报告研究,其具体体机制及治疗手段尚不清楚。全面透彻地理解ISNA的流行病学特征、病理学特征及病因机制不仅有助于预防和治疗支架后并发症,也能为新一代冠脉支架开发奠定基础。该文就ISNA与支架发展史、ISNA病理特征及ISNA病因机制的研究进展进行综述。

In-stent restenosis(ISR)and in-stent thrombosis(IST)are two major complications of percutaneous coronary intervention(PCI)and are also the main limiting factors in the treatment of obstructive coronary artery disease.In-stent neoatherosclerosis(ISNA)serves as the common pathological basis for ISR and IST.Current research on ISNA is mainly based on clinical imaging observations using optical coherence tomography(OCT),angioscopy,intravascular ultrasonography(IVUS),and autopsy reports.The specific mechanisms and treatment strategies for ISNA are not clear yet.A comprehensive understanding of the epidemiological characteristics,histological features,and pathogenic mechanisms of ISNA not only helps in the prevention and treatment of post-stent complications,but also lays the foundation for the development of the next generation of coronary stents.This review summarizes the research progress on the development history of ISNA,the pathological features of ISNA,and the pathogenic mechanisms of ISNA.