新一代冠状动脉支架与支架内血栓的临床研究进展
王佳鑫,刘越,尹新华,李为民
摘要(Abstract):
<正>药物洗脱支架(drug-eluting stent,DES)目前已经在冠心病治疗中发挥重要作用,但近年来大量临床研究证实以紫杉醇洗脱支架(paclitaxel-eluting stent,PES)和西罗莫司洗脱支架(sirolimus-eluting stent,SES)为代表的第一代DES在显著降低再狭窄率的同时增加了支架内血栓(stent thrombosis,ST)发生风险。ST虽然发生率较低,但是病死率高达20%~40%,是支架置入术后灾难性的并发症[1]。新一代冠脉支架的研发着眼于提高DES的安全性,从支架平台、载药聚合
关键词(KeyWords):
基金项目(Foundation): 中华医学会动脉粥样硬化专项基金(09010210176);; 黑龙江省科技攻关重大项目(GB08C402-02);; 黑龙江省杰出青年科学基金(JC201001)
作者(Author): 王佳鑫,刘越,尹新华,李为民
参考文献(References):
- [1]Holmes DR Jr,Kereiakes DJ,Garg S,et al.Stent thrombosis.J Am Coll Cardiol,2010,56:1357-1365.
- [2]Nakazawa G,Finn AV,Vorpahl M,et al.Coronary responses and differential mechanisms of late stent thrombosis attributed to first-generation sirolimus-and paclitaxel-eluting stents.J Am Coll Cardiol,2011,57:390-398.
- [3]Guagliumi G,Sirbu V,Musumeci G,et al.Examination of the in vivo mechanisms of late drug-eluting stent thrombosis:findings from optical coherence tomography and intravascular ultrasound imaging.JACC Cardiovasc Interv,2012,5:12-20.
- [4]Camici GG,Steffel J,Amanovic I,et al.Rapamycin promotes arterial thrombosis in vivo:implications for everolimus and zotarolimus eluting stents.Eur Heart J,2010,31:236-242.
- [5]Wang HJ,Huang H,Chuang YC,et al.Paclitaxel induces up-regulation of tissue factor in human aortic endothelial cells.Int Immunopharmacol,2009,9:144-147.
- [6]Ma Q,Zhou Y,Nie X,et al.Rapamycin affects tissue plasminogen activator and plasminogen activator inhibitorⅠexpression:a potential prothrombotic mechanism of drug-eluting stents.Angiology,2012,63:330-335.
- [7]Ishihara T,Awata M,Uematsu M,et al.Angioscopic assessment of arterial repair four to eight months after zotarolimus-eluting stent implantation:implications for late stent thrombosis.J Am Coll Cardiol,2011,57:E1846.
- [8]Garg S,Serruys P.Benefits of and safety concerns associated with drug-eluting coronary stents.Expert Rev Cardiovasc Ther,2010,8:449-470.
- [9]Stone GW,Rizvi A,Newman W,et al.Everolimus-eluting versus paclitaxel-eluting stents in coronary artery disease.N Engl J Med,2010,362:1663-1674.
- [10]Rber L,Magro M,Stefanini GG,et al.Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents:a prospective cohort study.Circulation,2012,125:1110-1121.
- [11]de la Torre Hernández JM,Alfonso F,Gimeno F,et al.Thrombosis of second-generation drug-eluting stents in real practice results from the multicenter Spanish registry ESTROFA-2(Estudio Espnol Sobre Trombosis de Stents Farmacoactivos de Segunda Generacion-2).JACC Cardiovasc Interv,2010,3:911-919.
- [12]Tada N,Virmani R,Grant G,et al.Polymer-free biolimus A9-coated stent demonstrates more sustained intimal inhibition,improved healing,and reduced inflammation compared with a polymer-coated sirolimus-eluting cypher stent in a porcine model.Circ Cardiovasc Interv,2010,3:174-183.
- [13]Barlis P,Regar E,Serruys PW,et al.An optical coherence tomography study of a biodegradable vs.durable polymer-coated limus-eluting stent:a LEADERS trial sub-study.Eur Heart J,2010,31:165-176.
- [14]Zhang L,Yuan J,Liu G,et al.One-year clinical outcome of a randomized trial of polymer-free paclitaxel-eluting stents versus biodegradable polymer-based rapamycin-eluting stents in patients with coronary heart disease.J Interv Cardiol,2012,25:604-610.
- [15]Serruys PW,Ormiston JA,Onuma Y,et al.A bioabsorbable everolimus-eluting coronary stent system(ABSORB):2-year outcomes and results from multiple imaging methods.Lancet,2009,373:897-910.
- [16]Dudek D,Onuma Y,Ormiston JA,et al.Four-year clinical follow-up of the ABSORB everolimus-eluting bioresorbable vascular scaffold in patients with de novo coronary artery disease:the ABSORB trial.EuroIntervention,2012,7:1060-1061.
- [17]Waksman R,Erbel R,Di Mario C,et al.Early-and long-term intravascular ultrasound and angiographic findings after bioabsorbable magnesium stent implantation in human coronary arteries.JACC Cardiovasc Interv,2009,2:312-320.
- [18]Klomp M,Beijk MA,Varma C,et al.1-year outcome of TRIAS HR(TRI-stent adjudication study-high risk of restenosis)a multicenter,randomized trial comparing genous endothelial progenitor cell capturing stents with drug-eluting stents.JACC Cardiovasc Interv,2011,4:896-904.