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E hoʻopaʻa inoa me kāu kikoʻī kikoʻī a me ka lāʻau lapaʻau kikoʻī o ka hoihoi a e hoʻohālikelike mākou i ka ʻike āu e hāʻawi ai me nā ʻatikala i loko o kā mākou waihona nui a leka uila iā ʻoe i kahi kope PDF.
ʻO Marta Francesca Brancati, 1 Francesco Burzotta, 2 Carlo Trani, 2 Ornella Leonzi, 1 Claudio Cuccia, 1 Filippo Crea2 1 Keʻena o Cardiology, Poliambulanza Foundation Hospital, Brescia, 2 Department of Cardiology, Catholic University of the Sacred Heart of Rome, Italy Abstract: Drug-Eluting barcutizes (DES) liʻiliʻi ma hope o nā stents (DES) liʻiliʻi ma hope o nā mea hao. ʻOiai, ʻoiai ka hoʻokomo ʻia ʻana o ka lua o ka hanauna DES i hoʻohālikelike ʻia i kēia ʻano i hoʻohālikelike ʻia me ka DES o ka hanauna mua, ke mau nei nā hopohopo koʻikoʻi e pili ana i nā hopena hope loa o ka hoʻokomo ʻana i ka stent, e like me ka stent thrombosis (ST) a me ka wehe ʻana o ka stent.ʻO Stenosis (ISR) kahi hanana pōʻino i hōʻemi nui ʻia ma o ka stenting optimized, ka hoʻolālā stent novel, a me ka lāʻau antiplatelet ʻelua. Ua hōʻike ʻia nā haʻawina o DES i nā hōʻike o ka ulu mau ʻana o ka neointimal i ka wā lōʻihi o ka hahai ʻana, kahi ʻano i kapa ʻia ʻo ka "hope catch-up".Hoʻohana pinepine ʻia ia e hoʻopau i ka angiography coronary diagnostic a hoʻokele i nā kaʻina hana intervention. BMS a me DES. No laila, ua lilo ka neo-atherosclerosis i mea hoʻopiʻi mua i ka pathogenesis o ka pau ʻole o ka stent hope. Hua'ōlelo: coronary stent, stent thrombosis, restenosis, neoatherosclerosis
ʻO ka hoʻopiʻi ʻana i ke kalapona ʻo Percutaneous coronary intervention (PCI) me ka hoʻokomo ʻana i ka stent ke kaʻina hana i hoʻohana nui ʻia no ka mālama ʻana i ka maʻi aʻaʻa coronary symptomatic, a ke hoʻomau nei ke ʻano o ka ʻenehana., mau pilikia nui.2-5
Inā he hanana pōʻino paha ka ST, ua hoʻopiʻi ʻia ka ʻike ʻana he maʻi maikaʻi loa ka ISR e nā hōʻike o ka maʻi coronary acute (ACS) i nā maʻi ISR.4
I kēia lā, ʻike ʻia ʻo intracoronary optical coherence tomography (OCT)6-9 i ka ʻenehana kiʻi kiʻi o kēia manawa, e hāʻawi ana i ka hoʻonā ʻoi aku ka maikaʻi ma mua o ka ultrasound intravascular (IVUS).
Ma 1964, ua wehewehe ʻo Charles Theodore Dotter lāua ʻo Melvin P Judkins i ka angioplasty mua.He lapaʻau hoʻololi ia akā ua loaʻa nā hemahema o ka pani ʻana o ka moku a me ka restenosis. -Dutch Stent Trial 15 a me ka Stent Restenosis Study 16, ua kākoʻo i ka palekana o ka stenting me ka dual antiplatelet therapy (DAPT) a me / a iʻole nā ​​hana hoʻolālā kūpono.17,18 Ma hope o kēia mau ho'āʻo, ua nui ka piʻiʻana o ka helu o nā PCI i hanaʻia.
Eia naʻe, ua ʻike koke ʻia ka pilikia o iatrogenic in-stent neointimal hyperplasia ma hope o ka waiho ʻana o BMS, ka hopena i ka ISR ma 20%-30% o nā lesions i mālama ʻia. .Ma 2005, 80%–90% o nā PCI a pau i hele pū me DES.
Loaʻa i nā mea āpau kona mau hemahema, a mai ka makahiki 2005, ua piʻi aʻe ka hopohopo e pili ana i ka palekana o ka "hanauna mua" DES, a ua hoʻomohala ʻia a hoʻokomo ʻia nā stents hou e like me 20,21.
ʻO ka BMS kahi pahu uea lahilahi mesh. Ma hope o ka ʻike mua ʻana me ka mauna "Wall", mauna ʻo Gianturco-Roubin a me Palmaz-Schatz mauna, nui nā BMS like ʻole i kēia manawa.
ʻEkolu mau manaʻo like ʻole e hiki ke hiki: coil, tubular mesh and slotted tube.Coil designs feature metal wires or strips for a circular coil shape;ʻO nā hoʻolālā tubular mesh e hōʻike ana i nā uwea i ʻōwili pū ʻia i loko o ka ʻupena a lilo i paipu;ʻO nā hoʻolālā pahu slotted he mau paipu metala i ʻoki ʻia i hana ʻia. Ua ʻokoʻa kēia mau mea hana (stainless steel, nichrome, cobalt chrome), hoʻolālā hoʻolālā (nā ʻano strut like ʻole a me nā laula, nā anawaena a me nā lōʻihi, ka ikaika radial, radiopacity) a me nā ʻōnaehana hoʻopuka (hoʻonui pono a i ʻole balloon-expandable).
ʻO ka mea maʻamau, ʻo ka BMS hou he ʻāpana cobalt-chromium, kahi e hopena ai i nā struts thinner me ka hoʻokele maikaʻi ʻana, e mālama ana i ka ikaika mechanical.
Loaʻa iā lākou kahi paepae stent metala (maʻamau he kila kila) a uhi ʻia me kahi polymer e hoʻoheheʻe i nā lāʻau anti-proliferative a / a i ʻole nā ​​​​anti-inflammatory therapeutics.
ʻO Sirolimus (ka mea i kapa ʻia ʻo rapamycin) i hoʻolālā mua ʻia ma ke ʻano he antifungal agent. ʻO kāna ʻano hana e pili ana i ka pale ʻana i ka holomua o ka cell cycle ma ke kāohi ʻana i ka hoʻololi ʻana mai ka pae G1 a i ka pae S a me ke kāohi ʻana i ka hoʻokumu ʻana o neointima. ʻehā
Ua ʻae mua ʻia ʻo Paclitaxel no ka maʻi maʻi ovarian, akā ʻo kona mau waiwai cytostatic ikaika - ke hoʻopaʻa nei ka lāʻau i nā microtubules i ka wā mitosis, alakaʻi i ka hopu ʻana o ka cell cycle a pale i ka hoʻokumu ʻana o neointimal - e hoʻohui i ka Taxus Express PES. no ka hoʻouna maʻalahi.
ʻO nā hōʻike paʻa mai nā loiloi ʻōnaehana ʻelua a me nā meta-analyses e hōʻike ana he ʻoi aku ka maikaʻi o ka SES ma mua o ka PES ma muli o nā haʻahaʻa haʻahaʻa o ISR a me ka revascularization moku pahuhopu (TVR), a me ke ʻano o ka hoʻonui ʻana i ka myocardial infarction (AMI) i ka cohort PES.27,28
ʻO nā mea hana lua i hoʻemi i ka mānoanoa strut, hoʻomaikaʻi i ka maʻalahi/deliverability, hoʻonui i ka polymer biocompatibility/drug elution profiles, a me nā kinetics re-endothelialization maikaʻi loa.
ʻO Taxus Elements kahi holomua hou me kahi polymer kū hoʻokahi i hoʻolālā ʻia e hoʻonui i ka hoʻokuʻu mua ʻana a me kahi ʻōnaehana platinum-chromium strut hou e hāʻawi ana i nā struts thinner a me ka radiopacity hoʻonui.
Hoʻokumu ʻia ka zotarolimus-eluting stent (ZES) Endeavor ma luna o kahi kahua kobalt-chromium stent ʻoi aku ka ikaika me ka ʻoi aku ka maʻalahi a me ka liʻiliʻi o ka stent strut size. ʻO Zotarolimus kahi analog sirolimus me nā hopena immunosuppressive like akā hoʻonui ʻia ka lipophilicity e hoʻomaikaʻi ai i ka pā moku. Ma hope o ka ho'āʻo mua o ENDEAVOR, ua hoʻohālikelike ka hoʻokolohua ENDEAVOR III me ZES me SES, i hōʻike i ka nui o ka nalowale o ka lumen hope a me ka ISR akā ʻoi aku ka liʻiliʻi o nā hanana cardiovascular adverse nui (MACE) ma mua o SES. , ʻaʻole i hōʻike ka hoʻāʻo PROTECT i ka ʻokoʻa o nā kumukūʻai ST ma waena o nā stents Endeavor a me Cypher.32
ʻO Endeavor Resolute kahi mea i hoʻomaikaʻi ʻia o ka Endeavor stent me kahi polymer ʻekolu-layer hou. ʻO ka Resolute Integrity hou (i kekahi manawa i kapa ʻia ʻo ke kolu o ka hanauna DES) ua hoʻokumu ʻia ma kahi kahua hou me ka hiki ke hāʻawi kiʻekiʻe (ka Integrity BMS platform), a me kahi puke, ʻoi aku ka biocompatible ʻekolu-layer polymer. ʻO ka Resolute me Xience V (everolimus-eluting stent [EES]) i hōʻike i ka haʻahaʻa ʻole o ka ʻōnaehana Resolute e pili ana i ka make a me ka hemahema lesion.33,34
ʻO Everolimus, kahi derivative o sirolimus, ʻo ia hoʻi kahi mea hoʻokaʻawale cell cycle i hoʻohana ʻia i ka hoʻomohala ʻana o Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium platform) EES. Ua hōʻike ka suppress SPIRIT trial 35-37 i ka hoʻomaikaʻi ʻana i ka hana a ua hoʻemi ʻia ka MACE me Xience V i hoʻohālikelike ʻia me PES, ʻoiai ʻo ka EXCELLENT hoʻāʻo i hōʻike i ka EES i nā mahina hope loa o SES ʻaʻole i nalowale nā ​​hanana ma hope o nā mahina 12. .38 I ka hopena, ua hōʻike ka Xience stent i nā mea maikaʻi ma mua o BMS i ka hoʻonohonoho ʻana o ST-segment elevation myocardial infarction (MI).39
ʻO ka EPCs kahi ʻāpana o nā cell circulating e pili ana i ka homeostasis vascular a me ka hoʻoponopono endothelial. ʻO ka hoʻonui ʻana i nā EPC ma ke kahua o ka ʻeha vascular e hoʻoikaika i ka re-endothelialization mua, hiki ke hōʻemi i ka hopena o ka hoʻāʻo mua ʻana o ST.EPC biology ma ke kahua o ka hoʻolālā stent ʻo ia ka CD34 antibody-coated caping Genous re-endothelialization. othelialization.ʻOiai ua hoʻoikaika nā haʻawina mua, hōʻike nā hōʻike hou i nā helu kiʻekiʻe o TVR.40
E noʻonoʻo ana i nā hopena hiki ke hoʻopōʻino i ka ho'ōla hoʻopaneʻe o ka polymer-induced, e pili ana i ka pilikia o ST, bioabsorbable polymers e hāʻawi i nā pono o DES, e pale ana i nā hopohopo lōʻihi e pili ana i ka hoʻomau polymer. 41
Loaʻa i nā mea bioabsorbable ka pōmaikaʻi o ka hāʻawi mua ʻana i ke kākoʻo mechanical ke noʻonoʻo ʻia ka elastic recoil a hōʻemi i nā pilikia lōʻihi e pili ana i nā struts metala e kū nei. a me ka efficacy o everolimus-eluting PLLA stents.43 ʻO ka lua o ka hanauna Absorb stent revision he mea hoʻomaikaʻi ma mua o ka mea ma mua me ka maikaʻi 2-makahiki follow-up.44 ʻO ka hoʻāʻo ABSORB II e hoʻomau nei, ka hoʻāʻo mua randomized e hoʻohālikelike ana i ka Absorb stent i ka Xience Prime stent, pono e hāʻawi i ka ʻikepili hou aʻe, a ʻo ka hoʻonohonoho mua ʻana i loaʻa i nā hopena maikaʻi loa. s pono e hoomaopopo pono.
ʻO ka thrombosis ma ka BMS a me ka DES he mau hopena maikaʻi ʻole. Ma kahi papa inoa o nā maʻi e loaʻa ana i ka DES implantation, 47 24% o nā hihia ST i make, 60% mai ka MI non-fatal, a me 7% mai ka angina paʻa ʻole.
Loaʻa i ka Advanced ST nā hopena hōʻeha maikaʻi ʻole. Ma ka haʻawina BASKET-LATE, 6 a 18 mau mahina ma hope o ka waiho ʻana i ka stent, ʻoi aku ka kiʻekiʻe o ka nui o ka make ʻana o ka naʻau a me ka MI non-fatal i ka hui DES ma mua o ka hui BMS (4.9% a me 1.3%, kēlā me kēia). ukali, SES (0.6% vs 0%, p = 0.025) a me PES (0.7%)) ua hoʻonui i ka nui o ka ST hope loa i hoʻohālikelike ʻia me BMS e 0.2%, p = 0.028).49 I ka hoʻohālikelike ʻana, i kahi meta-analysis me nā maʻi 5,108, 21 a 60% pili i ka hoʻonui ʻia ʻana o ka BMS i ka make a i ʻole MI. 5% ka piʻi nui ʻole (Follow-up 9 mahina a 3 makahiki).
Nui nā registries, randomized trials, a me meta-analyses i noiʻi i ka pili pili o ST ma hope o ka BMS a me DES implantation a ua hōʻike i nā hopena kū'ē. Ma kahi papa inoa o nā maʻi 6,906 e loaʻa ana i ka BMS a i ʻole DES, ʻaʻohe ʻokoʻa i nā hopena lapaʻau a i ʻole nā ​​helu ST i ka wā 1-makahiki follow-up. / makahiki i hoʻohālikelike ʻia me BMS.49 Ua hōʻike ʻia kahi meta-analysis o nā hoʻāʻo e hoʻohālikelike ana i ka SES a i ʻole PES me BMS i ka piʻi ʻana o ka pilikia o ka make a me ka MI me ka DES mua o ka hanauna mua i hoʻohālikelike ʻia me BMS, 21 a me kekahi meta-analysis o nā maʻi 4,545 randomized i SES a i ʻole ʻAʻohe ʻokoʻa i ka hanana o ST ma waena o PES a me BMS i 50 mau makahiki o ka loaʻa ʻana o ka maʻi ST a me ka BMS ma 50 mau makahiki o ka loaʻa hou ʻana o ka ST. -hanauna DES ma hope o ka pau ʻana o DAPT.51
Ma muli o nā hōʻike kū'ē'ē, ua hoʻoholo pū kekahi mau loiloi i hui pū ʻia a me nā meta-analyses ʻaʻole i ʻokoʻa nui ka DES a me BMS o ka hanauna mua i ka pilikia o ka make a i ʻole MI, akā ua piʻi aʻe ka SES a me PES i ka ST kiʻekiʻe loa i hoʻohālikelike ʻia me BMS.No ka nānā ʻana i nā hōʻike i loaʻa, ua koho ka US Food and Drug Administration (FDA) i kahi panela loea53 nāna i hoʻopuka i kahi ʻōlelo e hōʻoia ana he pono ka DES o ka hanauna mua no nā hōʻailona ma ka lepili a he liʻiliʻi ka pilikia o ST kiʻekiʻe loa.ʻO kahi hoʻonui nui. ʻO ka hopena, ʻōlelo ka FDA a me ka hui e hoʻolōʻihi i ka manawa DAPT i 1 makahiki, ʻoiai he liʻiliʻi ka ʻikepili e kākoʻo i kēia koi.
E like me ka mea i ʻōlelo ʻia ma mua, ua hoʻomohala ʻia ka DES lua me nā hiʻohiʻona hoʻolālā kiʻekiʻe. Ua loaʻa nā CoCr-EES i nā haʻawina hauʻoli nui loa. Ma kahi meta-analysis a Baber et al, 54 me 17,101 mau maʻi, CoCr-EES i hōʻemi nui i ka definite/probable ST a me MI i hoʻohālikelike ʻia me PES, SES, a me ZES ma hope o 21,7 mau mahina ma hope o ka 217 mau mahina. 75 nā maʻi i loaʻa i ka CoCr-EES i ka haʻahaʻa haʻahaʻa haʻahaʻa mua, hope, 1- a me 2-makahiki maʻamau ST i hoʻohālikelike ʻia me nā DES i hui pū ʻia.55 Ua hōʻike nā haʻawina honua maoli i ka emi ʻana o ka pilikia ST me CoCr-EES i hoʻohālikelike ʻia me DES.56 hanauna mua.
Ua hoʻohālikelikeʻiaʻo Re-ZES me CoCr-EES ma RESOLUTE-AC a me TWENTE ho'āʻo.33,57 ʻAʻohe mea nui i ka hopena o ka make, myocardial infarction, a i ʻole ST definite ma waena o nā stents ʻelua.
Ma kahi pūnaewele meta-analysis o nā maʻi 50,844 me 49 RCTs, ua pili ka 58CoCr-EES me kahi haʻahaʻa haʻahaʻa o ST definite ma mua o BMS, kahi hopena i ʻike ʻole ʻia ma DES ʻē aʻe;ʻaʻole wale ka emi ʻana ma Significant ma mua a ma 30 mau lā (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) a me 1 makahiki (OR 0.27, 95% CI 0.08-0.74) a me 2 makahiki (OR 0.35 CI , 0.95% me Z, 0.95% a me ZS. ʻO ES, CoCr-EES i pili me kahi haʻahaʻa haʻahaʻa o ST ma 1 makahiki.
ʻO ka ST mua e pili ana i nā mea like ʻole. Ke ʻike ʻia nei ka morphology plaque a me ke kaumaha thrombus i ka hopena ma hope o PCI;59 ʻO ke komo hohonu ʻana ma muli o ka necrotic core (NC) prolapse, nā waimaka medial i ka lōʻihi o ka stent, ka wehe ʻana i ke lua me nā koena palena, a i ʻole ka hōʻemi nui ʻana o ka palena ʻoi aku ka maikaʻi o ka stenting maikaʻi loa, ka hoʻopiʻi ʻole ʻana, a me ka hoʻonui ʻole ʻana. ua like nā tes (<1%).61 No laila, ʻike mua ʻia ka ST mua e pili ana i nā maʻi lapaʻau i lalo a me nā mea ʻokiʻoki.
I kēia mau lā, ʻike ʻia kahi manaʻo nui i ka ST hope loa / hope loa. , nā mea hoʻololi o ke kaʻina hana, e like me ka nui o ka moku liʻiliʻi, bifurcations, polyvascular maʻi, calcification, total occlusion, long stents, ikeia e pili ana me ka pilikia o ka holomua ST.62,63 Insufficient response to antiplatelet therapy is a major risk factor for advanced DES thrombosis 51 . This response might be due to patient nonadherence, underdosing, drugities interactions affects the genetic level. dogrel resistance), and upregulation of other platelet activation pathways.In-stent neoatherosclerosis ua manaʻo ʻia he ʻano hana nui o ka pau ʻole o ka stent hope, me ka ST64 hope loa (ʻāpana "In-stent neoatherosclerosis"). ʻO ka papa hana lāʻau-eluting me nā hopena likeʻole i ka ho'ōla a me ka hana o ka endothelial, me ka pilikia o ka thrombosis hope.65 Hōʻike nā haʻawina pathological e hiki i nā polymers lōʻihi o ka hanauna mua DES ke kōkua i ka mumū mau loa, ka waihoʻana o ka fibrin maʻamau, ka ho'ōla endothelial maikaʻiʻole, a me ka hopena i hoʻonuiʻia ka pilikia o ka thrombosis. ka hoʻonui ʻana i ka aneurysm ma ka ʻāpana stent me nā hopena hypersensitivity kūloko i haku ʻia me nā T lymphocytes a me nā eosinophils;Hiki i kēia mau ʻike ke hōʻike i ka mana o nā polymers nonerodible.67 ʻO ka malapposition stent ma muli paha o ka hoʻonui ʻia ʻana o ka stent suboptimal a i ʻole he mau mahina ma hope o PCI. ʻOiai ʻo ka malapposition kaʻina hana he mea pilikia no ka ST acute a me ka subacute ST, hiki ke hilinaʻi ke koʻikoʻi o ka loaʻa ʻana o ka stent malapposition i ka hoʻoponopono hou ʻana o ka arterial a i ʻole ka lāʻau lapaʻau.
Hiki i nā hopena pale o DES ka lua o ka hanauna ke komo i ka endothelialization wikiwiki a paʻa, a me nā ʻokoʻa o ka stent alloy a me ka hoʻolālā, ka mānoanoa strut, nā waiwai polymer, a me ke ʻano lāʻau antiproliferative, dosis, a me nā kinetics.
E pili ana me CoCr-EES, hiki ke kokua i ka ha'aha'a o ST. Ua hoikeia na ha'awina ho'okolohua 'o ka thrombosis a me ka platelet deposition o ka fluoropolymer-coated stents he mea like loa ia ma mua o ka nui o ka waiwai like o DE. s aʻo hou aku.
Hoʻomaikaʻi nā stents coronary i ka holomua o ka hana ʻana o ka coronary interventions i hoʻohālikelike ʻia me ka percutaneous transluminal coronary angioplasty (PTCA), nona nā pilikia mechanical (vascular occlusion, dissection, etc.) a me nā helu restenosis kiʻekiʻe (a hiki i 40%-50% o nā hihia).Ma ka hopena o nā makahiki 1990, kokoke 70% o nā PCI i hana ʻia me ka hoʻokomo ʻana o BMS.70
Eia naʻe, me ka holomua o ka ʻenehana, nā ʻenehana, a me nā lāʻau lapaʻau, ʻo ka pilikia o ka restenosis ma hope o ka hoʻokomo ʻana o BMS ma kahi o 20%, me ka> 40% i nā subgroups kikoʻī.
Hoʻemi hou ka DES i ka hopena o ISR,73 ʻoiai ʻo kēia hoʻemi e pili ana i ka angiography a me ka hoʻonohonoho hoʻonohonoho.75
ʻO kaʻeha vascular i ka PCI e hana i kahi hana paʻakikī o ka mumū a me ka hoʻoponoponoʻana i kahi manawa pōkole (he pule a hiki i nā mahina), e alakaʻi ana i ka endothelialization a me ka uhi neointimal. E like me ka nānāʻana i ka histopathological,ʻo ka hyperplasia neointimal (BMS a me DES) ma hope o ka hoʻokomoʻiaʻana o ka stent ka mea nui i hakuʻia me nā pūnaewele maʻemaʻe maʻemaʻe ma kahi proteoglycan-rich matrix.
No laila, neointimal hyperplasia hōʻike i ke kaʻina hana hoʻoponopono e pili ana i ka coagulation a me nā mea inflammatory a me nā pūnaewele e hoʻoulu ai i ka hoʻonuiʻana o ka muscle a me ka hoʻokumuʻana o ka matrix extracellular. 8) a me ka platelet glycoprotein Ibα 53 a i ʻole fibrinogen i paʻa i ka platelet glycoprotein IIb/IIIa.76,77
Wahi a nā ʻikepili e puka mai ana, pili nā pūpū progenitor i loaʻa i ka iwi iwi i nā pane vascular a me nā kaʻina hana hoʻoponopono. EPC;Ua hōʻike hou nā haʻawina hou i ka CD34 surface antigen e hoʻomaopopo maoli i nā pūnaewele iwi iwi i hoʻokaʻawale ʻole ʻia me ka hiki ke hoʻokaʻawale i nā EPC a me SMPC.ʻO nā kūlana ischemic e hoʻoulu i ka hoʻokaʻawale ʻana i ka phenotype EPC e hāpai i ka re-endothelialization, ʻoiai nā kūlana inflammatory e hoʻohuli i ka ʻokoʻa i ka SMPC phenotype e hāpai i ka neointimal proliferation.79
Hoʻonui ka maʻi diabetes i ka pilikia o ISR e 30% -50% ma hope o ka hoʻokomo ʻana o BMS, 80 a me ka piʻi ʻana o ka restenosis i nā maʻi maʻi diabetic i hoʻohālikelike ʻia me nā mea maʻi nondiabetic i hoʻomau pū ʻia i ka wā DES. sk o ISR.70
ʻO ke anawaena moku a me ka lōʻihi o ka liona i hoʻopili kūʻokoʻa i ka loaʻa ʻana o ka ISR, me ka liʻiliʻi liʻiliʻi / ʻoi aku ka lōʻihi o nā ʻeha e hoʻonui nui i ka restenosis i hoʻohālikelike ʻia me ka nui aʻe / pōkole pōkole.71
Ua hōʻike ʻia nā paepae stent o ka hanauna mua i nā stent struts mānoanoa a me nā helu ISR kiʻekiʻe aʻe i ka hoʻohālikelike ʻia me nā paepae stent lua o ka hanauna me nā struts thinner.
Eia kekahi, ua pili ka hopena o ka restenosis i ka lōʻihi o ka stent, me ka lōʻihi o ka stent> 35 mm kokoke i ʻelua manawa i ka lōʻihi o kēlā mau <20 mm.
ʻO ka mea maʻamau, ua manaʻo ʻia ka hyperplasia intimal ma hope o ka hoʻokomo ʻia ʻana o BMS, me kahi kiʻekiʻe mua ma waena o 6 mahina a me 1 makahiki, a ukali ʻia e kahi manawa quiescent hope. , nā haʻawina me ka hahai lōʻihi lōʻihi ua hōʻike i kahi pane triphasic ma hope o ka hoʻokomoʻana o BMS, me ka hoʻomaha mua, ka regression waena, a me ka restenosis lumen hope.84
I ka wā DES, ua hōʻike mua ʻia ka ulu ʻana o ka neointimal ma hope o ka hoʻokomo ʻana o SES a i ʻole PES i loko o nā ʻano holoholona.85 Ua hōʻike ʻia kekahi mau haʻawina IVUS i kahi attenuation mua o ka ulu ʻana o ka pilina ma hope o ka hopu ʻana i ka manawa ma hope o ka hoʻokomo ʻana o SES a i ʻole PES, ma muli paha o kahi kaʻina hana inflammatory.86
ʻOiai ka "paʻa" maʻamau i pili iā ISR, ma kahi o kahi hapakolu o nā maʻi BMS ISR e hoʻomohala i ka ACS.4
Ke hoʻonui nei nā hōʻike i ka hoʻoulu ʻana o ka maʻi maʻi a me / a i ʻole endothelial insufficiency i ka neoatherosclerosis kiʻekiʻe i loko o BMS a me DES (ʻoi aku ka nui o ka hanauna mua DES), ʻo ia paha kahi hana koʻikoʻi no ka ISR kiʻekiʻe a i ʻole ST.Inoue et al.Ua hōʻike ʻo 87 i nā ʻike histological mai nā laʻana autopsy ma hope o ka hoʻokomo ʻia ʻana o nā stents coronary Palmaz-Schatz, e hōʻike ana e hiki ke hoʻolalelale i ka ʻeha peri-stent i nā loli atherosclerotic indolent hou i loko o ka stent.Hōʻike nā laʻana mai nā hihia ACS i nā plaques vulnerable maʻamau i loko o nā aʻa coronary maoli. mau makahiki ma hope mai a ua mau ka loaʻa ʻole o ka loaʻa ʻana a hiki i nā makahiki 4. Eia kekahi, ʻo ka DES stenting no nā ʻeha paʻa ʻole e like me ka thin-cap fibroatherosclerosis (TCFA) a i ʻole ka ʻāʻī o ka intimal he manawa pōkole no ka hoʻomohala ʻana i hoʻohālikelike ʻia me BMS.
Ke aʻo ʻia nei ka hopena o ka lua o ka hanauna DES a i ʻole DES i ka hoʻomohala ʻana;ʻOiai ke hōʻike nei kekahi mau ʻike o ka lua o ka hanauna DESs88 i ka liʻiliʻi o ka mumū, ua like ka maʻi o ka neoatherosclerosis me ka hanauna mua, akā pono nā noiʻi hou aʻe.