支架内新生动脉粥样硬化研究进展

Progress of in-stent neoatherosclerosis

经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)彻底改变了冠心病的治疗方法。药物洗脱支架(drug-eluting stent,DES)则进一步成功地解决了早期支架内新生内膜过度生长的问题,降低了晚期血栓事件的风险,改善了患者的预后。然而,由于强大的抗内膜增生药物的影响,血管愈合时间大大延迟,包括晚期支架内血栓形成和晚期支架内再狭窄在内的晚期支架失败仍然是一个值得关注的问题,而越来越多的影像学及病理学证据表明,支架内新生动脉粥样硬化(in-stent neoatherosclerosis,ISNA)是导致晚期支架失败的重要原因。本文旨在从ISNA的流行病学、形态学特征、潜在机制等方面作一综述。

Percutaneous coronary intervention(PCI)has completely changed the treatment of coronary heart disease.The drug-eluting stent(DES)further successfully solve the problem of neointimal overgrowth in the early stage of stent implantation,reduce the risk of late thrombotic events,and improve the prognosis of patients.However,due to the anti-vascular endothelium drug,the time of vascular healing is greatly delayed.Late stent failure,including late stent thrombosis and late in-stent restenosis,remains a concern.A growing body of imaging and pathology evidence suggests that in-stent neoatherosclerosis(ISNA)is an important cause of late stent failure.This article aims to provide an overview of ISNA from epidemiology to potential mechanisms.