冠脉支架内再狭窄的危险因素和致病机制及治疗进展

Risk factors,pathogenic mechanisms and treatment progress of coronary in-stent restenosis

冠心病(CAD)已成为全球范围内导致人口死亡的主要原因之一。经皮冠状动脉介入治疗(PCI)是CAD的主要治疗手段之一。冠脉支架内再狭窄(ISR)是指PCI后,血管再次发生狭窄的情况,约占PCI后的10%左右。冠脉ISR是一种极为复杂的疾病,尽管其确切发病机制尚不清楚,但目前普遍认为其涉及炎症、增殖和基质血管重塑等过程。多种危险因素已被确定与冠脉ISR相关,包括炎症、遗传因素、患者斑块异质性,以及PCI手术中支架植入操作不当。识别这些因素不仅有助于对患者危险程度进行分类,还加深了我们对冠脉ISR的理解,从而有助于制定个体化的治疗方案。在过去的40年中,越来越多的新材料和技术被应用于冠脉ISR的预防与治疗,包括药物洗脱支架、新型药物治疗、先进的血管内成像技术、可生物降解支架以及细胞治疗和基因治疗等。尽管取得了这些进展,冠脉ISR仍然是PCI并发症中的重要问题,因此,认识冠脉ISR的危险因素、理解其致病机制,并探索新的治疗策略至关重要。本文旨在综述冠脉ISR的危险因素、致病机制和治疗方面的最新进展,以供临床医生和未来研究人员参考。

Coronary artery disease(CAD)has become one of the leading causes of death worldwide.Percutaneous coronary intervention(PCI)is one of the main treatments for CAD.Coronary in-stent restenosis(ISR)refers to the re-narrowing of the artery following PCI,occurring in approximately 10%of cases.Coronary ISR is a highly complex condition,and while its exact pathogenesis remains unclear,it is widely believed to involve processes such as inflammation,proliferation and stromal vascular remodeling.Several risk factors have been identified as being associated with coronary ISR,including inflammation,genetic predisposition,plaque heterogeneity,and improper stent placement during PCI.These factors not only help categorize patient risk but also deepen our understanding of coronary ISR,aiding in the development of individualized treatment plans.Over the past four decades,numerous new materials and techniques have been employed to prevent and treat coronary ISR,including drug eluting stents,innovative pharmacotherapies,advanced intravascular imaging techniques,biodegradable stents,as well as cell and gene therapies.Despite these advancements,coronary ISR remains a significant PCI complication.Thus,recognizing the risk factors,understanding the pathogenic mechanisms,and exploring new treatment strategies for coronary ISR are critical.This article aims to review the latest advancements in the risk factors,pathogenic mechanisms,and treatment of coronary ISR,providing reference for clinicians and future researchers.