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Marta Francesca Brancati, 1 Francesco Burzotta, 2 Carlo Trani, 2 Ornella Leonzi, 1 Claudio Cuccia, 1 Filippo Crea2 1 Department of Cardiology, Poliambulanza Foundation Hospital, Brescia, 2 Department of Cardiology, Jami'ar Katolika na Tsarkakkiyar Zuciya na Rome, Italiya Abstract Ministoci (MS) ) bayan tsaka-tsakin jijiyoyin jini na percutaneous. Duk da haka, kodayake gabatarwar DES na ƙarni na biyu ya bayyana cewa ya daidaita wannan al'amari idan aka kwatanta da ƙarni na farko na DES, damuwa mai tsanani ya kasance game da yiwuwar rikice-rikice na ƙarshe na stent implantation, irin su stent thrombosis (ST) da stent resection.Stenosis (ISR) .ST wani lamari ne mai yuwuwar bala'i wanda ya ragu sosai ta hanyar ingantaccen stenting, sabon ƙirar stent, da kuma maganin antiplatelet dual.Ainihin tsarin da ke bayyana abin da ya faru yana cikin bincike, kuma hakika, dalilai masu yawa suna da alhakin.ISR a cikin BMS an yi la'akari da shi azaman tsayayyen yanayi tare da farkon kololuwa na tsawon watanni 6. duka na asibiti da na tarihi na DES sun nuna shaida na ci gaba da ci gaban neointimal a lokacin bin dogon lokaci, wani abu da aka sani da "marigayi kama". tanti jirgin warkar;ana amfani da shi sau da yawa don kammala bincike na angiography na jijiyoyin jini da kuma fitar da hanyoyin shiga tsakani.Intracoronary optical coherence tomography a halin yanzu ana la'akari da mafi kyawun fasahar hoto. Idan aka kwatanta da duban dan tayi na intravascular, yana ba da mafi kyawun ƙuduri (aƙalla> sau 10), yana ba da cikakken bayani game da tsarin farfajiya na bangon jirgin ruwa. BMS da DES.Saboda haka, neo-atherosclerosis ya zama farkon wanda ake zargi a cikin pathogenesis na marigayi stent gazawar.Keywords: jini stent, stent thrombosis, restenosis, neoatherosclerosis.
Ƙwararrun ƙwayar cuta ta jiki (PCI) tare da ƙaddamar da stent shine hanya mafi yadu da ake amfani da ita don maganin cututtuka na cututtuka na jijiyoyin jini, kuma fasahar ta ci gaba da samuwa., damuwa mai tsanani ya rage.2-5
Idan ST wani lamari ne mai yuwuwar bala'i, sanin cewa ISR cuta ce mai ƙarancin ƙima ta kwanan nan an ƙalubalanci shaidar rashin lafiyar zuciya (ACS) a cikin marasa lafiya na ISR.4
A yau, intracoronary optical coherence tomography (OCT) 6-9 ana la'akari da fasaha na zamani na zamani, yana ba da mafi kyawun ƙuduri fiye da duban dan tayi na intravascular (IVUS)."
A cikin 1964, Charles Theodore Dotter da Melvin P Judkins sun bayyana angioplasty na farko. A cikin 1978, Andreas Gruntzig ya yi aikin angioplasty na balloon na farko (balloon angioplasty a fili);Wannan magani ne na juzu'i amma yana da ragi na rufewa da jirgin ruwa na marigayi.13 Wannan ko da yake ɓarnatar da abubuwan da aka fitar da shi na farko. S, fitinar Belgium ta Belgium 15 da kuma matattarar da aka yi nazarin 16 ,,10 bayan wadannan fitilun, akwai karuwa da yawa cikin adadin PCIS.
Duk da haka, matsalar iatrogenic in-stent neointimal hyperplasia da ke bin BMS an gano shi da sauri, wanda ya haifar da ISR a cikin 20% -30% na raunuka da aka yi da su. Fting.A cikin 2005, 80% -90% na duk PCIs sun kasance tare da DES.
Komai yana da rauninsa, kuma tun daga 2005, damuwa game da lafiyar "ƙarni na farko" DES ya tashi, kuma an samar da sababbin sababbin abubuwa kamar 20,21 da kuma gabatar da su.
BMS shine bututun waya na bakin ciki.
Zaɓuɓɓuka daban-daban guda uku suna yiwuwa: naɗa, raga tubular da bututu mai ramuka. Zane-zanen naɗa yana nuna wayoyi na ƙarfe ko ɗigon da aka kafa zuwa siffar madauwari;Tsarin raga na tubular yana nuna wayoyi da aka naɗe tare a cikin raga don samar da bututu;slotted tube kayayyaki kunshi karfe shambura da aka Laser yanke made.These na'urorin bambanta a cikin abun da ke ciki (bakin karfe, nichrome, cobalt chrome), tsarin zane (daban-daban strut alamu da nisa, diamita da tsawo, radial ƙarfi, radiopacity) da kuma bayarwa tsarin (kai-fadada ko balloon-expandable) .
Gabaɗaya, sabon BMS ya ƙunshi haɗin cobalt-chromium, wanda ke haifar da ƙananan struts tare da ingantaccen kewayawa, kiyaye ƙarfin injina.
Sun ƙunshi dandali na stent na ƙarfe (yawanci bakin karfe) kuma an rufe shi da polymer wanda ke kawar da maganin rigakafi da / ko maganin kumburi.
Sirolimus (wanda aka fi sani da rapamycin) an tsara shi ne a matsayin wakili na antifungal. Tsarin aikinsa ya fito ne daga toshe ci gaba da sake zagayowar tantanin halitta ta hanyar toshe sauye-sauye daga lokaci na G1 zuwa lokaci S da hana tsarin neointima. nty hudu
An fara yarda da Paclitaxel don ciwon daji na ovarian, amma halayen cytostatic mai karfi - miyagun ƙwayoyi yana tabbatar da microtubules a lokacin mitosis, yana haifar da kamawar kwayar halitta kuma ya hana tsarin neointimal - sanya shi fili don Taxus Express PES. TaxUS V da VI gwaje-gwaje sun nuna tasiri na tsawon lokaci na PES, CASTERY 2 CASTERY 2 CASRICERY 2 CASTER. ya fito da wani dandali na bakin karfe don sauƙin bayarwa.
Shaida ta ƙarshe daga sake dubawa na tsari guda biyu da meta-bincike sun nuna cewa SES yana da fa'ida akan PES saboda ƙananan ƙimar ISR da revascularization na jirgin ruwa (TVR), da kuma yanayin haɓakar ƙwayar cuta mai ƙwayar cuta (AMI) a cikin ƙungiyar PES.27,28
Na'urori na ƙarni na biyu sun rage kauri na strut, ingantacciyar sassauƙa / isarwa, ingantattun bayanan martaba na polymer biocompatibility / miyagun ƙwayoyi, da kuma kyakkyawan yanayin sake-endothelialization.
Taxus Elements shine ƙarin ci gaba tare da polymer na musamman da aka tsara don ƙaddamar da farkon saki da sabon tsarin platinum-chromium strut wanda ke samar da ƙananan strut da inganta radiopacity.The PERSEUS fitina 29 lura irin wannan sakamakon tsakanin Element da Taxus Express har zuwa watanni 12. Duk da haka, gwaji kwatanta yew abubuwa tare da sauran na biyu-ƙarni DES ne.
Zotarolimus-eluting stent (ZES) Endeavor yana dogara ne akan dandamali mai ƙarfi na cobalt-chromium tare da mafi girman sassauci da ƙananan stent strut size. eluted a lokacin farkon rauni na farko, ya biyo bayan gyaran gyare-gyare na arterial.Bayan gwajin ENDEAVOR na farko, gwajin ENDEAVOR III na gaba idan aka kwatanta da ZES tare da SES, wanda ya nuna hasara mafi girma a ƙarshen lumen da ISR amma ƙananan manyan cututtuka na zuciya da jijiyoyin jini (MACE) fiye da SES. a cikin rukunin ZES.31 Duk da haka, gwajin PROTECT ya kasa nuna bambanci a cikin ƙimar ST tsakanin Endeavor da Cypher stent.32
Endeavor Resolute shine ingantaccen sigar Endeavor stent tare da sabon nau'in polymer mai Layer uku. Sabon Resolute Integrity (wani lokaci ana magana da shi azaman ƙarni na uku DES) yana dogara ne akan sabon dandamali tare da damar isarwa mafi girma (Dandalin Integrity BMS), da kuma wani labari, ƙarin biocompatible biocompatible uku-Layer press polymer , zai iya haifar da kumburi na gaba kwanaki 6. aring Resolute tare da Xience V (everolimus-eluting stent [EES]) ya nuna rashin ƙanƙantar tsarin ƙuduri dangane da mutuwa da raunin rauni.33,34
Everolimus, wanda ya samo asali ne daga sirolimus, kuma mai hana hawan kwayar halitta da aka yi amfani da shi a cikin ci gaban Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium dandamali) EES. Gwajin SPIRIT 35-37 ya nuna ingantaccen aiki kuma ya rage MACE tare da Xience V idan aka kwatanta da PES, yayin da EXCELLES EXCELLES ba a nuna rashin lafiya ba a cikin watannin da ba a tabbatar da su ba. al events at 12 months.38 A ƙarshe, Xience stent ya nuna abũbuwan amfãni a kan BMS a cikin saitin ST-segment elevation myocardial infarction (MI).39
EPCs wani yanki ne na sel masu yawo da ke cikin gidaostasis na jijiyoyin jini da gyaran endothelial. Inganta EPCs a wurin rauni na jijiyoyin jini zai haɓaka farkon sake dawo da endothelialization, mai yuwuwar rage haɗarin ST.EPC na farko na yunƙurin ilimin halitta a fagen ƙirar stent shine CD34 antibody-coated Genous snding ta hanyar haɓakar EPC ta hanyar haɓakar EPC. lialization.Ko da yake binciken farko ya ƙarfafa, shaidun kwanan nan sun nuna yawan adadin TVR.40
Yin la'akari da abubuwan da za su iya haifar da jinkirin warkarwa na polymer, wanda ke da alaƙa da haɗarin ST, masu amfani da kwayoyin halitta suna ba da fa'idodin DES, da guje wa damuwa na dogon lokaci game da juriya na polymer. Har zuwa yau, an yarda da tsarin daban-daban na bioabsorbable (misali Nobori da Biomatrix, biolimus eluting stent, Synergy, EES, EES, SES, goyon bayan sakamako mai tsawo), 4.
Abubuwan da za a iya amfani da su suna da fa'idar fa'ida ta farko ta samar da tallafin injiniya lokacin da aka yi la’akari da sake dawowa na roba da rage haɗarin dogon lokaci da ke da alaƙa da struts na ƙarfe na zamani.Sabbin fasahohin fasaha sun haifar da haɓakar polymers na tushen lactic acid (poly-l-lactic acid [PLLA]), amma yawancin tsarin stent suna cikin haɓaka, kodayake ƙayyadaddun ma'auni mai kyau tsakanin ƙalubalen ƙalubalen muggan ƙwayoyi da ƙarancin ƙarancin gwaji na ABRB. mus-eluting PLLA stent.43 Na biyu-ƙarni Absorb stent bita ya kasance wani ci gaba a kan wanda ya gabata tare da mai kyau 2 shekaru biyo baya. bayyana.
Thrombosis a cikin BMS da DES suna da mummunan sakamako na asibiti. A cikin rajista na marasa lafiya da ke karɓar DES implantation, 47 24% na lokuta na ST sun haifar da mutuwa, 60% daga MI maras mutuwa, da 7% daga angina maras tabbas.PCI a cikin gaggawa ST yawanci ba shi da kyau, tare da sake dawowa a cikin 184% na lokuta.
Advanced ST yana da yiwuwar sakamako mara kyau na asibiti.A cikin binciken BASKET-LATE, 6 zuwa watanni 18 bayan sanyawa a cikin stent, yawan adadin mace-mace na zuciya da marasa mutuwa MI sun kasance mafi girma a cikin ƙungiyar DES fiye da a cikin ƙungiyar BMS (4.9% da 1.3%, bi da bi). a cikin shekaru 4 na biyo baya, SES (0.6% vs 0%, p = 0.025) da PES (0.7%)) ya karu da yawancin ST da aka kwatanta da BMS ta 0.2%, p = 0.028) .49 Sabanin haka, a cikin wani bincike-bincike ciki har da 5,108 marasa lafiya, 21 a 60% na MS da aka ruwaito tare da mutuwar 3 (S) tare da 0. hade da 15% karuwa mara mahimmanci (Biyan watanni 9 zuwa shekaru 3).
Yawancin rajista, gwaje-gwajen bazuwar, da meta-bincike sun binciki haɗarin dangi na ST bayan BMS da DES dasawa kuma sun bayar da rahoton sakamakon rikice-rikice. % / shekara idan aka kwatanta da BMS.49 A meta-bincike na gwaje-gwaje kwatanta SES ko PES tare da BMS ya nuna wani ƙarin hadarin mace-mace da MI tare da ƙarni na farko DES idan aka kwatanta da BMS, 21 da kuma wani meta-analysis na 4,545 marasa lafiya bazuwar zuwa SES ko Babu wani bambanci a cikin abin da ya faru na ST tsakanin PES da BMS na ci-gaba da bincike-a 4 shekaru da aka nuna a cikin wani ci-gaba da bincike na MIST. karbar DES na farko bayan dakatar da DAPT.51
Idan aka ba da hujjoji masu karo da juna, da yawa da aka tattara bayanai da meta-bincike tare sun ƙaddara cewa ƙarni na farko na DES da BMS ba su bambanta sosai a cikin haɗarin mutuwa ko MI ba, amma SES da PES suna da haɗarin haɓakar ST sosai idan aka kwatanta da BMS.Don duba Shaidar da ke akwai, Hukumar Kula da Abinci da Magunguna ta Amurka (FDA) ta nada ƙwararrun kwamitin53 wanda ya ba da sanarwar yarda cewa ƙarni na farko na DES yana da tasiri ga alamomin alamar kuma haɗarin ST na ci gaba kaɗan ne amma ƙarami.Haɓakawa mai mahimmanci.A sakamakon haka, FDA da ƙungiyar sun ba da shawarar tsawaita lokacin DAPT zuwa shekara 1, kodayake akwai ƙananan bayanai don tallafawa wannan da'awar.
Kamar yadda aka ambata a baya, an haɓaka ƙarni na biyu na DES tare da sifofin ƙira masu haɓakawa.CoCr-EESs sun sami mafi girman karatun asibiti.A cikin meta-bincike ta Baber et al,54 ciki har da marasa lafiya na 17,101, CoCr-EES ya rage tabbataccen tabbatacce / mai yiwuwa ST da MI idan aka kwatanta da PES, SES, da ZES bayan 21, Palme da ZES a cikin watanni 21. CoCr-EES yana da mahimmanci a farkon farkon, marigayi, 1- da 2-shekara tabbatacciyar ST idan aka kwatanta da sauran DES.55 Nazarin na ainihi ya nuna raguwa a cikin hadarin ST tare da CoCr-EES idan aka kwatanta da DES.56 na farko.
An kwatanta Re-ZES tare da CoCr-EES a cikin RESOLUTE-AC da gwaji na TWENTE.33,57 Babu wani bambanci mai mahimmanci a cikin abin da ya faru na mace-mace, ciwon zuciya na zuciya, ko tabbataccen ST tsakanin stents guda biyu.
A cikin meta-bincike na cibiyar sadarwa na marasa lafiya 50,844 ciki har da 49 RCTs, 58CoCr-EES an danganta shi da ƙarancin ƙarancin tabbataccen ST fiye da BMS, sakamakon ba a lura da shi a cikin wasu DES;raguwa ba kawai a cikin Mahimmanci da wuri ba kuma a cikin kwanakin 30 (rabo maras kyau [OR] 0.21, 95% tazarar amincewa [CI] 0.11-0.42) da kuma a shekara ta 1 (OR 0.27, 95% CI 0.08-0.74) da 2 shekaru (OR 0.35-ES0, 9.5% S, 9.9, PCI, 0.35-ES, 9.9.9). da ZES, CoCr-EES an haɗa shi da ƙananan abin da ya faru na ST a 1 shekara.
Farkon ST yana da alaƙa da dalilai daban-daban. Ƙarƙashin ƙwayar ƙwayar ƙwayar cuta da nauyin thrombus ya bayyana yana tasiri sakamakon bayan PCI;59 Deeper strut shigar azzakari cikin farji saboda necrotic core (NC) prolapse, medial hawaye a cikin stent tsawo, na biyu dissection tare da saura margins, ko gagarumin gefe narrowing Mafi kyau duka stenting, incomplete appposition, da kuma m fadada60 Jiyya tsarin tare da antiplatelet kwayoyi ba ya tasiri a cikin ST da wuri a lokacin gwaji da kuma m a lokacin gwaji na ST. kwatanta BMS tare da ƙimar DES sun kasance iri ɗaya (<1%).61 Don haka, farkon ST ya bayyana yana da alaƙa da farko ga cututtukan cututtuka da kuma abubuwan tiyata.
A yau, wani musamman mayar da hankali ne a kan marigayi / sosai marigayi ST. Idan matakai da fasaha dalilai sun bayyana suna taka muhimmiyar rawa a cikin ci gaban m da subacute ST, da tsarin na jinkirta thrombotic al'amurran da suka shafi ya bayyana ya zama mafi rikitarwa.An nuna cewa wasu halaye na haƙuri iya zama hadarin dalilai ga ci-gaba da kuma sosai ci-gaba ST: ciwon sukari, ACS a lokacin farko tiyata, renal gazawar, ci-gaba shekaru, da raguwa a cikin manyan cututtuka na eje a cikin kwanaki eje 3. ES, masu canji na tsari, irin su ƙananan ƙananan jirgin ruwa, bifurcations, cututtuka na polyvascular, calcification, jimlar occlusion, dogon lokaci, sun bayyana suna hade da hadarin ci gaba na ST.62,63 Rashin isasshen amsa ga maganin antiplatelet shine babban haɗari ga ci gaba na DES thrombosis 51 . Wannan amsa zai iya zama saboda rashin haƙuri, rashin daidaituwa na ƙwayar cuta, haɗin gwiwar kwayoyin halitta, haɗin gwiwar kwayoyin halitta da kwayoyin halitta. (musamman juriya na clopidogrel), da haɓakar wasu hanyoyin kunnawa platelet.In-stent neoatherosclerosis ana daukar shi wani muhimmin tsari na ƙarshen stent gazawar, ciki har da marigayi ST64 (sashe "In-stent neoatherosclerosis").Cibiyar endothelium mara kyau yana raba bangon thrombosed thrombosed da stent struts daga jini ya kwarara kuma yana ɓoye ɓarnawar bangon jijiyoyin jini. kwayoyi da dandamali na maganin miyagun ƙwayoyi tare da tasiri daban-daban akan warkaswa na endothelial da aiki, tare da hadarin marigayi thrombosis.65 Nazarin ilimin cututtuka sun nuna cewa polymers masu ɗorewa na ƙarni na farko na DES na iya ba da gudummawa ga ƙumburi na yau da kullum, ƙaddamarwar fibrin na yau da kullum, rashin lafiya na endothelial warkarwa, da kuma sakamakon karuwar hadarin thrombosis .3 Late hypersensitivity to post-STV machines ya bayyana zuwa wani post-STV. fadada aneurysm a sashin stent tare da halayen hypersensitivity na gida wanda ya ƙunshi T lymphocytes da eosinophils;waɗannan binciken na iya nuna tasirin polymers marasa ƙarfi.67 Stent malapposition na iya zama saboda ƙananan haɓakar stent ko kuma ya faru watanni bayan PCI.Ko da yake tsarin malapposition yana da haɗari ga ST mai tsanani da kuma subacute ST, ma'anar asibiti na samun stent malapposition na iya dogara ne a kan m arterial remodeling ko magani-samun jinkirin da magani-induced.
Tasirin kariyar DES na ƙarni na biyu na iya haɗawa da ƙarin saurin haɓakawa da haɓakawa, da kuma bambance-bambance a cikin gami da tsarin stent, kauri mai ƙarfi, kaddarorin polymer, da nau'in ƙwayar cuta na antiproliferative, kashi, da motsa jiki.
Dangantakar da CoCr-EES, bakin ciki (81 µm) cobalt-chromium stent struts, antithrombotic fluoropolymers, low polymer, da miyagun ƙwayoyi loading na iya ba da gudummawa ga ƙananan abin da ya faru na ST.Nazarin gwaji ya nuna cewa thrombosis da platelet deposition na fluoropolymer-coated stents suna da muhimmanci fiye da na biyu-genetal Properties. kara karatu.
Ƙwararrun ƙwayoyin cuta suna inganta ƙimar nasarar aikin tiyata na cututtukan zuciya idan aka kwatanta da na gargajiya na al'ada na al'ada na al'ada (PTCA), wanda ke da rikice-rikice na inji (ruwan jini, rarrabawa, da dai sauransu) da kuma yawan restenosis (har zuwa 40% -50% na lokuta).A ƙarshen 1990s, kusan 70% na PCIs an yi su tare da dasa BMS.70
Duk da haka, duk da ci gaba a cikin fasaha, fasaha, da jiyya na likita, haɗarin restenosis bayan dasawa na BMS shine kusan 20%, tare da> 40% a cikin ƙungiyoyin ƙayyadaddun ƙayyadaddun .71 Gabaɗaya, nazarin asibiti ya nuna cewa restenosis bayan dasa BMS, kama da abin da aka lura da PTCA na al'ada, kololuwa a watanni 3-6 kuma ya warware bayan shekara 172.
DES ya kara rage yawan abin da ya faru na ISR,73 ko da yake wannan raguwa ya dogara ne akan angiography da kuma asibiti. Rubutun polymer a kan DES ya saki magungunan anti-inflammatory da anti-proliferative agents, ya hana tsarin neointima, kuma yana jinkirta tsarin gyaran jijiyoyi na tsawon watanni zuwa shekaru. karatu.75
Raunin jijiyoyin jini a lokacin PCI yana haifar da tsari mai rikitarwa na kumburi da gyare-gyare a cikin ɗan gajeren lokaci (makonni zuwa watanni), wanda ke haifar da endothelialization da ɗaukar hoto na neointimal.A cewar bayanan histopathological.
Don haka, hyperplasia neointimal yana wakiltar tsarin gyaran gyare-gyaren da ya shafi coagulation da abubuwan kumburi da kuma kwayoyin da ke haifar da yaduwar ƙwayar tsoka mai santsi da kuma samar da matrix na waje. Nan da nan bayan PCI, platelets da fibrin ajiya a kan bangon jirgin ruwa da kuma daukar nauyin leukocytes ta hanyar jerin kwayoyin mannewa ta hanyar kwayoyin halitta. da platelet glycoprotein Ibα 53 ko fibrinogen da aka ɗaure zuwa platelet glycoprotein IIb/IIIa.76,77
Dangane da fitowar bayanai, sel na mashin ƙashi wanda ke da hannu a cikin abin da ya haifar da ƙwayar cuta mai zurfi. " 78 A baya, an dauke sel mai kyau CD34-Kyawun da aka tsara na EPCs;Raba karatun ya nuna cewa CD34 surface antigen ya fahimci sel mai ban mamaki a cikin EPCs da Slercs.transdedDiation Sells na CD34-Kyakkyawan Kwayoyin CD34-Kyakkyawan Kwayoyin CD34 ya dogara da yanayin yanki;Yanayin ischemic yana haifar da bambance-bambance zuwa nau'in EPC don inganta sake dawowa, yayin da yanayin kumburi ya haifar da bambanci zuwa ga SMPC phenotype don inganta haɓakar neointimal.79
Ciwon sukari yana ƙara haɗarin ISR ta 30%-50% bayan dasa BMS,80 da kuma mafi girma na restenosis a cikin marasa lafiya masu ciwon sukari idan aka kwatanta da marasa lafiya marasa ciwon sukari kuma sun ci gaba da kasancewa a cikin zamanin DES. Hanyoyin da ke tattare da wannan lura suna iya zama masu yawa, sun haɗa da tsarin tsarin (misali, sauye-sauye a cikin amsawar kumburi, ƙananan ƙwayoyin cuta, da dai sauransu) da ƙananan ƙwayoyin cuta (misali. ly Hadarin ISR.70
Diamita na jirgin ruwa da tsayin raunin da kansa ya shafi abin da ya faru na ISR, tare da ƙaramin diamita / raunuka masu tsayi da yawa suna haɓaka ƙimar restenosis idan aka kwatanta da babban diamita / gajeriyar raunuka.71
Matakan dandali na ƙarni na farko sun nuna kauri mai kauri da ƙimar ISR mafi girma idan aka kwatanta da dandamali na stent na ƙarni na biyu tare da ƙananan struts.
Bugu da ƙari, abin da ya faru na restenosis yana da alaƙa da tsayin stent, tare da tsayin stent> 35 mm kusan sau biyu idan dai wadanda <20 mm. Ƙarshen stent mafi ƙarancin lumen diamita shima ya taka muhimmiyar rawa: ƙaramin ƙaramin ƙaramin lumen na ƙarshe ya annabta haɓakar haɗarin restenosis.81,82
A al'ada, hyperplasia na intimal bayan dasa BMS ana la'akari da kwanciyar hankali, tare da farkon kololuwa tsakanin watanni 6 da shekara 1, biye da ƙarshen quiescent period. An ba da rahoton farkon kololuwar girma na cikin ciki a baya, wanda ya biyo baya tare da haɓakar lumen shekaru da yawa bayan stent implantation; , Nazarin tare da dogon lokaci mai tsawo sun nuna amsawar triphasic bayan sanyawa BMS, tare da farfadowa na farko, tsaka-tsakin tsaka-tsakin, da kuma ƙarshen lumen restenosis.84
A cikin zamanin DES, an fara nuna ci gaban neointimal na ƙarshe bayan ƙaddamarwar SES ko PES a cikin nau'ikan dabbobi.85 Yawancin nazarin IVUS sun nuna farkon haɓakar girma na ciki wanda ya biyo baya bayan lokaci bayan SES ko PES implantation, mai yiwuwa saboda ci gaba mai kumburi tsari.86
Duk da "kwantar da hankali" a al'adance ga ISR, kusan kashi ɗaya bisa uku na marasa lafiya na BMS ISR suna haɓaka ACS.4
Akwai ƙara shaida cewa kumburi na kullum da / ko endothelial rashin isa ya haifar da ci-gaba neoatherosclerosis a cikin BMS da DES (yafi na farko-ƙarni DES), wanda zai iya zama wani muhimmin tsari ga ci-gaba ISR ko ci-gaba ST.Inoue et al.87 ya ruwaito binciken binciken tarihi daga samfurori na autopsy bayan dasawa na Palmaz-Schatz jijiyoyin jini, yana ba da shawarar cewa kumburi na peri-stent na iya haɓaka sabbin sauye-sauye na atherosclerotic a cikin stent.Wasu binciken10 sun nuna cewa nama na restenotic a cikin BMS, sama da shekaru 5, ya ƙunshi sabbin cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan cututtukan da kuma ba tare da kumburi ba.samfurori daga lokuta na ACS suna nuna alamun cututtuka na al'ada a cikin jijiyoyin jini na asali na asali na tarihin ilimin lissafi na toshe tare da macrophages foamy da cholesterol crystals. Bugu da ƙari, lokacin da aka kwatanta BMS da DES, an lura da babban bambanci a lokacin ci gaba da sabon atherosclerosis. ions ya faru shekaru 2 bayan haka kuma ya kasance wani binciken da ba a sani ba har sai shekaru 4. Bugu da ƙari kuma, DES stenting don cututtuka marasa ƙarfi irin su bakin ciki-cap fibroatherosclerosis (TCFA) ko rupture na ciki yana da ɗan gajeren lokaci zuwa ci gaba idan aka kwatanta da BMS. Saboda haka, neoatherosclerosis ya bayyana ya zama na kowa kuma yana faruwa a baya a cikin ƙarni na farko na DES fiye da a cikin BMS.
Tasirin ƙarni na biyu na DES ko DES a cikin haɓaka ya kasance don yin nazari;ko da yake wasu abubuwan lura na ƙarni na biyu na DESs88 sun ba da shawarar ƙarancin kumburi, abin da ke faruwa na neoatherosclerosis yana kama da na ƙarni na farko, amma ana buƙatar ƙarin bincike.