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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, Catholic University of the Sacred Heart of Rome, Italy Abstract Minit: Stents-Elu Metal stent (BMS) mgbe ntinye aka nke akwara obi. Otú ọ dị, ọ bụ ezie na ntinye nke ọgbọ nke abụọ DES yiri ka ọ kwadoro ihe a ma e jiri ya tụnyere ọgbọ mbụ nke DES, nchegbu siri ike na-anọgide na-enwe nsogbu ndị nwere ike ime n'oge na-adịghị agwụ agwụ nke ntinye stent, dị ka stent thrombosis (ST) na stent resection. Stenosis (ISR) .ST bụ ihe omume nwere ike ịkpata ọdachi nke e belatara nke ukwuu site na stenting kachasị mma, atụmatụ stent novel, na ọgwụgwọ antiplatelet dual. A na-enyocha usoro kpọmkwem nke na-akọwa ihe mere ya, na n'ezie, ọtụtụ ihe kpatara ya. A na-ewere ISR na BMS dị ka ọnọdụ na-adịgide adịgide nke nwere mmalite mmalite nke hyperplasia na-esote ọnwa 6. afọ. N'ụzọ dị iche, ma nchọpụta ụlọ ọgwụ na akụkọ ihe mere eme nke DES gosipụtara ihe àmà nke ọganihu neointimal na-adịgide adịgide n'oge ogologo oge na-esochi ya, ihe a maara dị ka ihe ngosi "mbubreyo". atherosclerotic plaques na akụkụ nke ọgwụgwọ arịa post-stent; A na-ejikarị ya eme ihe iji mezue diagnostic coronary angiography na ụgbọala usoro ntinye aka. Intracoronary optical coherence tomography ka a na-ewere ugbu a dị ka usoro nyocha nke kachasị elu. E jiri ya tụnyere ultrasound intravascular, ọ na-enye mkpebi ka mma (opekata mpe> ugboro 10), na-enye ohere ịkọwapụta nkọwa zuru ezu nke nhazi elu nke mgbidi arịa ahụ. neo-atherosclerosis n'ime BMS na DES.Ya mere, neo-atherosclerosis aghọwo isi a na-enyo enyo na pathogenesis nke ọdịda stent ọdịda.Keywords: coronary stent, stent thrombosis, restenosis, neoatherosclerosis.
Percutaneous coronary intervention (PCI) na ntinye stent bụ usoro a na-ejikarị eme ihe maka ọgwụgwọ ọrịa akwara na-akpata mgbaàmà, na usoro ahụ na-aga n'ihu na-amalite. , oké nchegbu ka dị.2-5
Ọ bụrụ na ST bụ ihe omume nwere ike ịkpata ọdachi, amata na ISR bụ ọrịa na-adịghị mma ka agbaala aka n'oge na-adịbeghị anya site n'ihe akaebe nke nnukwu ọrịa coronary syndrome (ACS) na ndị ọrịa ISR.4
Taa, intracoronary optical coherence tomography (OCT) 6-9 ka a na-ewere dị ka usoro ihe ngosi nke ugbu a, na-enye mkpebi dị mma karịa ultrasound intravascular (IVUS).
N'afọ 1964, Charles Theodore Dotter na Melvin P Judkins kọwara angioplasty mbụ. Na 1978, Andreas Gruntzig rụrụ balloon angioplasty nke mbụ (plain old balloon angioplasty); ọ bụ ọgwụgwọ mgbanwe ma nwee ihe ndọghachi azụ nke nnukwu mmechi ụgbọ mmiri na restenosis.13 Nke a mere ka a chọpụta stent nke akwara obi: Puel na Sigwart wepụtara stent mbụ nke akwara obi na 1986, na-enye stent iji gbochie nnukwu mmechi arịa na mbubreyo systolic mbubreyo. mbufụt. Mgbe e mesịrị, ule abụọ dị ịrịba ama, Belgian-Dutch Stent Trial 15 na Stent Restenosis Study 16, kwadoro nchekwa nke stenting na dual antiplatelet therapy (DAPT) na / ma ọ bụ usoro ntinye kwesịrị ekwesị .17,18 Mgbe ule ndị a gasịrị, enwere mmụba dị ukwuu na ọnụ ọgụgụ nke PCI rụrụ.
Otú ọ dị, nsogbu nke iatrogenic in-stent neointimal hyperplasia na-esote BMS a chọpụtara ngwa ngwa, na-akpata ISR na 20%-30% nke ọnya a na-emeso ya. Na 2001, e webatara DES19 iji belata mkpa nke restenosis na reintervention.DES emewo ka obi ike nke ndị ọkà mmụta obi na-eme ka obi sie ike, na-ekwe ka a na-edozi ọnụ ọgụgụ ndị na-agbagwoju anya na mbụ. N'afọ 2005, 80%-90% nke PCI niile sonyeere DES.
Ihe niile nwere ihe ndọghachi azụ ya, na ebe ọ bụ na 2005, nchegbu banyere nchekwa nke "ọgbọ mbụ" DES ebiliwo, na stent nke ọgbọ ọhụrụ dị ka 20,21 e mepụtara ma webata ya.
BMS bụ eriri waya dị nro. Mgbe ahụmahụ mbụ na ugwu "Mgbidi", Gianturco-Roubin ugwu na Palmaz-Schatz ugwu, ọtụtụ BMS dị iche iche dị ugbu a.
Nhazi atọ dị iche iche ga-ekwe omume: eriri igwe, ntupu tubular na tube nke oghere. tubular ntupu aghụghọ na-egosi wires jikọtara ọnụ na ntupu na-etolite a tube; slotted tube aghụghọ mejupụtara ígwè tubes na laser ịkpụ made.These ngwaọrụ dịgasị iche iche na mejupụtara (igwe anaghị agba nchara, nichrome, cobalt chrome), structural imewe (iche strut ụkpụrụ na widths, diameters na ogologo, radial ike, radiopacity) na nnyefe usoro (onwe-agbasawanye ma ọ bụ balloon-expandable) .
N'ozuzu, BMS ọhụrụ ahụ nwere alloy cobalt-chromium, nke na-ebute struts dị gịrịgịrị nwere ike ịnyagharị ka mma, na-ejigide ike ọrụ.
Ha na-agụnye ikpo okwu stent metal (na-emekarị igwe anaghị agba nchara) ma kpuchie ya na polymer nke na-eme ka ọgwụgwọ mgbochi na / ma ọ bụ mgbochi mkpali.
Ebubere Sirolimus (nke a makwaara dị ka rapamycin) dị ka onye na-ahụ maka ọgwụ nje. Usoro ọrụ ya na-esite na igbochi ọganihu nke usoro cell site na igbochi mgbanwe site na G1 na-aga n'ihu na S na igbochi nhazi neointima. Na 2001, "ahụmahụ mbụ n'ime mmadụ" na SES gosipụtara nsonaazụ na-ekwe nkwa, na-eduga na mmepe nke ule nke Cypher . igbochi ISR.iri abụọ na anọ
A kwadoro Paclitaxel na mbụ maka ọrịa cancer ovarian, ma ihe ndị nwere ike cytostatic - ọgwụ ahụ na-eme ka microtubules guzosie ike n'oge mitosis, na-eduga na njide cell cell ma na-egbochi nhazi neointimal - mee ka ọ bụrụ ogige maka Taxus Express PES. Ọnwụnwa TAXUS V na VI gosipụtara ogologo oge arụmọrụ nke PES, ọrịa coronant2 dị elu. TAXUS Liberté gosipụtara ikpo okwu igwe anaghị agba nchara maka nnyefe dị mfe.
Ihe akaebe zuru oke sitere na nyocha usoro abụọ na meta-nyocha na-egosi na SES nwere uru karịa PES n'ihi ntakịrị ọnụ ọgụgụ nke ISR na revascularization arịa (TVR), yana omume na-abawanye nnukwu myocardial infarction (AMI) na PES cohort. 27,28
Ngwaọrụ ọgbọ nke abụọ ebelatala ọkpụkpụ strut, mgbanwe mgbanwe / nnyefe dị mma, profaịlụ polymer biocompatibility / ọgwụ elution, yana ezigbo re-endothelialization kinetics. N'ime omume nke oge a, ha bụ atụmatụ DES kachasị elu na nnukwu stent coronary kụnyere n'ụwa nile.
Taxus Elements bụ a n'ihu ọganihu na a pụrụ iche polymer e mere ka maximize n'oge ntọhapụ na a ọhụrụ platinum-chromium strut usoro na-enye thinner struts na enwekwukwa radiopacity.The PERSEUS ikpe 29 kwuru yiri results n'etiti Element na Taxus Express ruo 12 months. Otú ọ dị, ọnwụnwa na-atụnyere yew ọcha na ndị ọzọ nke abụọ-ọgbọ DES bụ ndị ọzọ lacking.
The zotarolimus-eluting stent (ZES) Endeavor dabeere na ike cobalt-chromium stent n'elu ikpo okwu na elu mgbanwe na nta stent strut size. mbufụt.Ọtụtụ ọgwụ na-apụ n'anya n'oge mbụ mmerụ ahụ na-esote, nke na-esote ya bụ nrụzi akwara. Mgbe mbụ ikpe ENDEAVOR nke mbụ, ikpe ENDEAVOR III na-esote ya tụnyere ZES na SES, nke gosipụtara nnukwu oge lumen ọnwụ na ISR ma ọ bụ obere ihe ndị na-adịghị mma nke ọrịa obi (MACE) karịa SES. AMI, o yiri ka ọ si na ST dị elu na otu ZES.31 Otú ọ dị, nnwale PROTECT egosighị ọdịiche dị na ọnụego ST n'etiti Endeavor na Cypher stent.32
Endeavor Resolute bụ ụdị dị mma nke Endeavor stent na polymer ọhụrụ atọ.The Newer Resolute Integrity (mgbe ụfọdụ a na-akpọ DES ọgbọ nke atọ) dabeere na ikpo okwu ọhụrụ nke nwere ikike nnyefe dị elu (The Integrity BMS platform), na akwụkwọ akụkọ, ọzọ biocompatible atọ oyi akwa polymer nwere ike ime ka mmeghachi omume mbụ nke 6 dị elu karịa polymer. days.A ikpe tụnyere Resolute na Xience V (everolimus-eluting stent [EES]) gosiri na-adịghị ala nke Resolute usoro n'ihe banyere ọnwụ na lesion ọdịda.33,34
Everolimus, nke sitere na sirolimus, bụkwa onye na-eme ihe nchịkwa nke cell na-eji na mmepe nke Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium platform) EES. The SPIRIT trial 35-37 gosipụtara arụmọrụ dị mma ma belata MACE na Xience V ma e jiri ya tụnyere PES, ebe ọ bụ na ọ dịghị ihe na-eme ka ọ dị mma na-egosi na ọ dịghị ihe na-eme ka ọ dị ntakịrị na-egosi na EESIN. Ọnwa 9 na ihe omume ụlọ ọgwụ na ọnwa 12.38 N'ikpeazụ, Xience stent gosipụtara uru karịa BMS na nhazi nke ST-segment elevation myocardial infarction (MI) .39
EPCs bụ akụkụ nke mkpụrụ ndụ na-ekesa na-etinye aka na vaskụla homeostasis na endothelial repair.Enwe EPC na saịtị nke vaskụla mmerụ ahụ ga-akwalite mmalite re-endothelialization, nwere ike ibelata ihe ize ndụ nke ST.EPC ihe omumu ihe omumu nke mbu n'ubi nke stent imewe bụ CD34 mgbochi-kpuchie Genous snding site na CD34 na-ekesa Genous stent nke na-ekesa ya. kwalite re-endothelialization.Ọ bụ ezie na ọmụmụ ihe mbụ na-agba ume, ihe àmà na-adịbeghị anya na-egosi ọnụ ọgụgụ dị elu nke TVR.40
N'iburu n'uche mmetụta ndị nwere ike imebi ihe nke ọgwụgwọ na-egbu oge nke polymer, nke jikọtara ya na ihe ize ndụ nke ST, ndị na-emepụta ihe ndị na-emepụta ihe na-enye uru nke DES, na-ezere nchegbu dị ogologo oge banyere nnọgidesi ike polymer. Ka ọ dị ugbu a, a kwadoro usoro dị iche iche nke bioabsorbable (eg Nobori na Biomatrix, biolimus eluting stent, Synergy, EES, EES, SES, SES, SES, na-akwado ogologo oge, ihe na-eme ka ọ pụta ìhè).
Bioabsorbable ihe nwere theoretical uru nke ibido na-enye n'ibu nkwado mgbe na-agbanwe recoil na-atụle na ibelata ogologo oge ize ndụ metụtara na ẹdude metal struts.Teknụzụ ọhụrụ emewo ka mmepe nke lactic acid dabeere polymers (poly-l-lactic acid [PLLA]), ma ọtụtụ stent usoro na-na mmepe, ọ bụ ezie na-ekpebi ndị ezigbo nguzozi n'etiti ọgwụ elution na ABRBs na-anọgide na-egosi na ihe ịma aka nchekwa na-anọgide na-emepe emepe. Efficacy of everolimus-eluting PLLA stent.43 Ọgbọ nke abụọ Absorb stent revision bụ ihe na-emeziwanye karịa nke gara aga nke nwere ezigbo afọ 2 na-esochi. profaịlụ nchekwa maka ọnya akwara dị mkpa ka edokwuo anya nke ọma.
Thrombosis na BMS na DES nwere nsonaazụ ụlọ ọgwụ na-adịghị mma. Na ndekọ nke ndị ọrịa na-anata ntinye DES, 47 24% nke ST kpatara ọnwụ, 60% sitere na MI na-adịghị egbu egbu, na 7% site na angina na-adịghị akwụ ụgwọ.PCI na mberede ST na-abụkarị suboptimal, na nlọghachi na 12% nke ikpe.
Advanced ST nwere ike oghom ụlọ ọgwụ pụta.N'ime BASKET-LATE ọmụmụ, 6 ka 18 ọnwa mgbe stent etinyere, ọnụego nke obi na-anwụ anwụ na ndị na-abụghị ọnwụ MI dị elu na DES otu karịa na BMS otu (4.9% na 1.3%, n'otu n'otu). BMS, kọrọ na na 4 afọ nke nlebanya, SES (0.6% vs 0%, p=0.025) na PES (0.7%) mụbara omume nke ukwuu mbubreyo ST ma e jiri ya tụnyere BMS site 0.2%, p=0.028) .49 N'ụzọ dị iche, na meta-analysis gụnyere 5,108 ọrịa, 0.21 a kọrọ na ọnwụ na BMS tụnyere 6 ọrịa. (p=0.03), ebe PES jikọtara ya na mmụba 15% na-adịghị mkpa (Na-esote ọnwa 9 ruo afọ 3).
Ọtụtụ ndebanye aha, ule ndị a na-atụghị anya ya, na meta-analyses enyochawo ihe ize ndụ dị n'ihe ize ndụ nke ST mgbe BMS na DES kụnyere ya ma kọọ akụkọ ndị na-emegiderịta onwe ha. N'ime ndekọ nke ndị ọrịa 6,906 na-anata BMS ma ọ bụ DES, ọ dịghị ihe dị iche na nsonaazụ ụlọ ọgwụ ma ọ bụ ọnụego ST n'oge 1 afọ na-esochi. bụrụ 0.6% / afọ ma e jiri ya tụnyere BMS.49 A meta-analysis of tests tụnyere SES ma ọ bụ PES na BMS gosipụtara ihe ize ndụ dị ukwuu nke ịnwụ anwụ na MI na ọgbọ mbụ DES ma e jiri ya tụnyere BMS, 21 na ọzọ meta-analysis nke 4,545 ọrịa randomized na SES ma ọ bụ Ọ dịghị ihe dị iche na omume nke ST n'etiti PES na ndị ọzọ na-esochi ọmụmụ ihe n'ezie nke BMS. ihe ize ndụ dị elu nke ST na MI dị elu na ndị ọrịa na-anata DES ọgbọ mbụ mgbe ịkwụsị DAPT.51
N'inye ihe akaebe na-emegiderịta onwe ya, ọtụtụ nyocha agbakọtara na meta-nyocha ọnụ kpebiri na ọgbọ mbụ DES na BMS adịghị iche n'ihe ize ndụ nke ọnwụ ma ọ bụ MI, mana SES na PES nwere nnukwu ohere nke ST dị elu ma e jiri ya tụnyere BMS. Iji nyochaa ihe akaebe dị, US Food and Drug Administration (FDA) họpụtara ọkachamara panel53 nke wepụtara nkwupụta na-ekwenye na ọgbọ mbụ DES dị irè maka akara ngosi akara yana na ihe ize ndụ nke ST dị elu dị ntakịrị ma dị ntakịrị. Mmụba dị ịrịba ama. N'ihi ya, FDA na ndị otu na-akwado ịgbatị oge DAPT ruo 1 afọ, ọ bụ ezie na enwere ntakịrị data iji kwado nkwupụta a.
Dị ka e kwuru na mbụ, nke abụọ-emana DES na elu imewe atụmatụ e mepụtara.CoCr-EESs emewo ihe kasị ukwuu clinical ọmụmụ.Na a meta-analysis site Baber et al,54 gụnyere 17,101 ọrịa, CoCr-EES budata belata definite / puru omume ST na MI tụnyere PES, SES, na ZES mgbe 21 ọnwa 21. Ndị ọrịa 16,775 na CoCr-EES nwere ntakịrị ala n'oge, mbubreyo, 1- na 2-afọ doro anya ST ma e jiri ya tụnyere ndị ọzọ na-agbakọta DES.55 Nnyocha ụwa egosila mbelata nke ihe ize ndụ ST na CoCr-EES ma e jiri ya tụnyere ọgbọ mbụ DES.56
E jiri ya tụnyere Re-ZES na CoCr-EES na RESOLUTE-AC na ule TWENTE.33,57 Ọ dịghị ihe dị iche iche dị ịrịba ama na ọnụọgụ ọnwụ, myocardial infarction, ma ọ bụ ST doro anya n'etiti stent abụọ ahụ.
Na meta-analysis nke netwọk nke ndị ọrịa 50,844 gụnyere 49 RCTs, 58CoCr-EES jikọtara ya na ọnụ ọgụgụ dị ala nke ST doro anya karịa BMS, nsonaazụ ahụghị na DES ndị ọzọ; Mbelata ahụ abụghị naanị n'oge dị ịrịba ama na na ụbọchị 30 (oke nha [OR] 0.21, 95% interval [CI] 0.11-0.42) nakwa na 1 afọ (OR 0.27, 95% CI 0.08-0.74) na 2 afọ (OR 0.35-0.0.9) PES, SES, na ZES, CoCr-EES jikọtara ya na obere ọnọdụ ST na 1 afọ.
Early ST metụtara ihe dị iche iche. N'okpuru morphology plaque na thrombus ibu na-egosi na-emetụta pụta mgbe PCI; 59 miri emi strut penetration n'ihi necrotic core (NC) prolapse, medial anya mmiri na ogologo stent, nke abụọ dissection na residual akụkụ, ma ọ bụ ịrịba n'ókè narrowing kacha mma stenting, ezughị ezu apposition, na ezughị ezu mgbasa 60 Ọgwụgwọ usoro na antiplatelet ọgwụ adịghị emetụta ST n'oge na subcidence nke DAPT n'oge mpụta nke ST. ule a na-atụghị anya ya na-atụnyere BMS na ọnụego DES yiri (<1%).61 Ya mere, mmalite ST yiri ka ọ bụ isi ihe metụtara ọnya ọgwụgwọ na ihe ịwa ahụ.
Taa, a akpan akpan na-elekwasị anya na mbubreyo / nnọọ mbubreyo ST. Ọ bụrụ na usoro na teknuzu ihe na-egosi na-ekere òkè dị ukwuu na mmepe nke nnukwu na subacute ST, usoro nke egbu oge thrombotic omume yiri ka ihe mgbagwoju anya.A na-atụ aro na ụfọdụ ndị ọrịa àgwà nwere ike ịbụ ihe ize ndụ maka elu na nnọọ elu ST: ọrịa shuga, ACS n'oge mbụ ịwa ahụ, gbasara akụrụ ọdịda, nnukwu afọ, belatara ihe omume n'ime mbụ adverse 3. Ịwa ahụ.N'ihi na BMS na DES, usoro mgbanwe mgbanwe, dị ka obere arịa size, bifurcations, polyvascular ọrịa, calcification, ngụkọta occlusion, ogologo stent, na-egosi na-ejikọta ya na ihe ize ndụ nke elu ST.62,63 Nzaghachi na-ezughị ezu na ọgwụgwọ antiplatelet bụ isi ihe ize ndụ maka elu DES thrombosis 51 .Nzaghachi a nwere ike ịdabere na mmekọrịta ọgwụ na-eme ka ọ bụrụ na ọ na-eme ka ọ bụrụ na ọ na-eme ka ọ bụrụ na ọ na-eme ka ọ ghara ịdị na-eme ihe na-adịghị mma. nzaghachi, polymorphisms mkpụrụ ndụ ihe nketa na ọkwa nnabata (karịsịa nguzogide clopidogrel), na nchikota nke ụzọ ndị ọzọ na-arụ ọrụ platelet.In-stent neoatherosclerosis ka a na-ewere dị ka usoro dị mkpa nke ọdịda stent mbubreyo, gụnyere mbubreyo ST64 (ngalaba "In-stent neoatherosclerosis"). Endothelium na-emebi emebi na-ekewapụ arịa ọbara thrombosed na mgbochi arịa ọbara na mgbochi arịa ọbara na mgbidi nzuzo. vasodilatory.DES na-ekpughere mgbidi arịa ahụ na ọgwụ mgbochi ọrịa na ikpo okwu na-emepụta ọgwụ na-enwe mmetụta dị iche iche na ọgwụgwọ endothelial na-arụ ọrụ, na-enwe ihe ize ndụ nke thrombosis n'oge .65 Pathological Studies na-atụ aro na polymers na-adịgide adịgide nke ọgbọ mbụ DES nwere ike itinye aka na mbufụt na-adịghị ala ala, nkwụsị nke fibrin na-adịghị ala ala, ọrịa endothelial na-adịghị ala ala, na-eme ka ọ bụrụ ihe ize ndụ nke hyperthrombosis. usoro ọzọ na-eduga na ST.Virmani et al66 kọrọ nchọpụta post-mortem post-ST na-egosi mgbasawanye aneurysm na akụkụ stent na mmeghachi omume hypersensitivity mpaghara nke mejupụtara T lymphocytes na eosinophils; Nchọpụta ndị a nwere ike igosi mmetụta nke polymers na-adịghị .67 Stent malapposition nwere ike ịbụ n'ihi suboptimal stent gbasaa ma ọ bụ mee ọnwa ole na ole mgbe PCI.
Mmetụta nchebe nke ọgbọ nke abụọ DES nwere ike ịgụnye njedebe ngwa ngwa na nke na-adịghị emebi emebi, yana ọdịiche dị na stent alloy na nhazi, ọkpụrụkpụ strut, polymer Njirimara, na ụdị ọgwụ mgbochi proliferative, dose, na kinetics.
N'ihe metụtara CoCr-EES, mkpa (81 µm) cobalt-chromium stent struts, antithrombotic fluoropolymers, obere polymer, na ọgwụ loading nwere ike itinye aka na obere ọnọdụ nke ST.Nnwale nyocha egosiwo na thrombosis na platelet deposition nke fluoropolymer mkpuchi stents dị nnọọ ala karịa ndị ọzọ-genetal D. nwere ihe ndị yiri ya kwesịrị inwekwu ọmụmụ ihe.
Ụkwụ akwara na-eme ka ọganiihu nke ịwa ahụ nke ntinye aka nke akwara obi ma e jiri ya tụnyere omenala percutaneous transluminal coronary angioplasty (PTCA), nke nwere nsogbu usoro (occlusion vascular, dissection, wdg) na ọnụ ọgụgụ restenosis dị elu (ruo 40%-50% nke ikpe). Ka ọ na-erule ngwụsị 1990s, ihe fọrọ nke nta ka ọ bụrụ 70% nke PCI ka ejiri ntinye BMS rụọ ọrụ.70
Otú ọ dị, n'agbanyeghị ọganihu na nkà na ụzụ, usoro, na ọgwụgwọ ahụike, ihe ize ndụ nke restenosis mgbe ntinye BMS dị ihe dịka 20%, na> 40% na obere subgroups .71 N'ozuzu, nchọpụta ụlọ ọgwụ egosiwo na restenosis mgbe ntinye BMS, dị ka nke a na-ahụ na PTCA omenala, ọnụ ọgụgụ kasị elu na ọnwa 3-6 ma kpebie mgbe afọ 172 gasịrị.
DES na-ebelata ohere nke ISR,73 ọ bụ ezie na mbelata a na-adabere na angiography na ọnọdụ ụlọ ọgwụ. Ihe mkpuchi polymer na DES na-ewepụta ihe ndị na-egbochi ọrịa na-egbu egbu na ndị na-emepụta ihe na-emepụta ihe, na-egbochi nhazi nke neointima, ma na-egbu oge nhazi nhazi vaskụla ruo ọnwa ruo ọtụtụ afọ. Clinical na histological ọmụmụ. 75
Vascular mmerụ ahụ n'oge PCI na-emepụta a mgbagwoju usoro nke mbufụt na nrụzi na a dịtụ mkpirikpi oge (izu ruo ọnwa), na-eduga endothelialization na neointimal cover.Dịka histopathological observations, na neointimal hyperplasia (BMS na DES) mgbe stent implantation bụ tumly mejupụtara proliferative smoothglycan cell.
Ya mere, hyperplasia neointimal na-anọchi anya usoro nrụzi nke metụtara coagulation na ihe ndị na-egbuke egbuke yana sel ndị na-ebute mmụba nke mkpụrụ ndụ dị nro na nhazi nke matrix extracellular. (CD11b/CD18) na platelet glycoprotein Ibα 53 ma ọ bụ fibrinogen jikọtara ya na platelet glycoprotein IIb/IIIa.76,77
Dị ka data na-apụta, mkpụrụ ndụ ndị na-emepụta ụmị ọkpụkpụ na-etinye aka na nzaghachi vaskụla na usoro nrụzi. Ịkwalite EPCs site na ụmị ọkpụkpụ n'ime ọbara dị n'akụkụ na-akwalite mmeghari endothelial na postnatal neovascularization.Ọ na-egosi na ụmị ọkpụkpụ smooth muscle progenitor sel (SMPC) na-akwaga na saịtị nke vaskụla mmerụ ahụ, na-eduga na mbụ ndụ mkpụrụ ndụ CDinin-38. a na-ewere dị ka ọnụ ọgụgụ ndị EPC nke edobere; Nnyocha ndị ọzọ egosila na CD34 antigen n'ezie na-amata mkpụrụ ndụ ụmị ọkpụkpụ na-enweghị atụ na-enwe ike ịmata ọdịiche dị n'ime EPC na SMPCs.Ngbanwe nke mkpụrụ ndụ CD34 dị mma na usoro EPC ma ọ bụ SMPC na-adabere na gburugburu ebe obibi; Ọnọdụ ischemic na-eme ka ọdịiche dị n'akụkụ phenotype EPC iji kwalite re-endothelialization, ebe ọnọdụ mkpali na-eme ka ọdịiche dị n'akụkụ SMPC phenotype iji kwalite mmụba neointimal.79
Ọrịa shuga na-abawanye ohere nke ISR site na 30%-50% mgbe etinyere BMS,80 na mmụba dị elu nke restenosis na ndị ọrịa na-arịa ọrịa shuga ma e jiri ya tụnyere ndị ọrịa na-arịa ọrịa shuga na-adịgidekwa n'oge DES. Usoro ndị dị n'okpuru nleba anya a nwere ike ịbụ multifactorial, gụnyere sistemu sistemu (dịka, mgbanwe dị ogologo na nzaghachi mkpali, ogologo ntachi obi, diamita nke ọrịa) na akwara anụ ahụ (dịka ọmụmaatụ. wdg) ihe na-abawanye onwe ya Egwu nke ISR.70
Dayameta ụgbọ mmiri na ogologo ọnya n'adabereghị na ọnọdụ nke ISR, na obere dayameta / ogologo ọnya na-abawanye ụba restenosis nke ukwuu ma e jiri ya tụnyere nnukwu dayameta / ọnya dị mkpụmkpụ.71
Usoro ikpo okwu stent nke ọgbọ mbụ gosipụtara stent stent na ọnụego ISR dị elu ma e jiri ya tụnyere nyiwe stent nke ọgbọ nke abụọ nwere struts dị gịrịgịrị.
Tụkwasị na nke ahụ, ihe gbasara restenosis metụtara ogologo stent, na ogologo stent> 35 mm fọrọ nke nta ka ọ bụrụ okpukpu abụọ ogologo oge nke <20 mm. The ikpeazụ stent kacha nta lumen dayameta na-arụkwa ọrụ dị mkpa: a obere ikpeazụ kacha nta lumen dayameta buru amụma na a budata ihe ize ndụ nke restenosis.81,82.
Na omenala, hyperplasia intimal na-esote BMS ịkụnye a na-ewere dị ka ihe kwụsiri ike, na ọnụ ọgụgụ mbụ dị n'etiti ọnwa 6 na 1 afọ, na-esote oge nkwụsịtụ oge. A na-akọbu ọnụ ọgụgụ mbụ nke mmụba nke mmekọrịta chiri anya, nke na-esote ya na mmụba nke lumen ọtụtụ afọ mgbe etinyere stent; .83 Otú ọ dị, ọmụmụ ihe ndị na-esochi ogologo oge na-adịte aka egosiwo nzaghachi triphasic mgbe ntinye BMS gasịrị, na mmalite restenosis, nkwụsị nke etiti, na nkwụsịtụ lumen.84.
Na oge DES, mbubreyo neointimal na mmalite gosipụtara na-esote SES ma ọ bụ PES ịkụnye n'ụdị anụmanụ .85 Ọtụtụ nchọpụta IVUS egosiwo nrịbawanye nke mmalite nke uto na-esote na njedebe oge na-esote oge mgbe SES ma ọ bụ PES tinyechara, ikekwe n'ihi usoro mkpali na-aga n'ihu.86
N'agbanyeghị "nkwụsi ike" nke a na-akpọ ISR na omenala, ihe dị ka otu ụzọ n'ụzọ atọ nke ndị ọrịa BMS ISR na-etolite ACS.4
Enwere ihe akaebe na-abawanye na mbufụt na-adịghị ala ala na / ma ọ bụ endothelial insufficiency na-ebute neoatherosclerosis dị elu n'ime BMS na DES (karịsịa ọgbọ mbụ DES), nke nwere ike ịbụ usoro dị mkpa maka ISR dị elu ma ọ bụ ST.Inoue et al. 87 kọrọ histological nchoputa site autopsy samples na-esonụ implantation nke Palmaz-Schatz coronary stent, na-atụ aro na peri-stent mbufụt nwere ike mee ngwangwa ọhụrụ indolent atherosclerotic mgbanwe n'ime stent. Ndị ọzọ ọmụmụ10 gosiri na restenotic anụ ahụ n'ime BMS, n'elu 5 afọ, mejupụtara ọhụrụ apụta atherosclerosis-, ma ọ bụ na-enweghị mbufụt; samples si ACS ikpe na-egosi ahụkarị adịghị ike plaques na ala akwara obi akwara akụkọ ihe mere eme morphology nke ngọngọ na foamy macrophages na cholesterol kristal. Tụkwasị na nke ahụ, mgbe atụnyere BMS na DES, a dị ịrịba ama dị iche na oge mmepe nke ọhụrụ atherosclerosis. na BMS ọnya mere 2 afọ mgbe e mesịrị ma nọgide na-adịghị ahụkebe nchoputa ruo afọ 4. Ọzọkwa, DES stenting maka ọnya na-ejighị n'aka dị ka thin-cap fibroatherosclerosis (TCFA) ma ọ bụ intimal rupture nwere oge dị mkpirikpi na mmepe ma e jiri ya tụnyere BMS. Ya mere, neoatherosclerosis yiri ka ọ na-emekarị ma na-eme na mbụ na ọgbọ mbụ nke MS dị iche iche na-adabere na BES.
Mmetụta nke ọgbọ nke abụọ DES ma ọ bụ DES na mmepe ka ga-amụ; ọ bụ ezie na ụfọdụ nlebanya dị ugbu a nke ọgbọ nke abụọ DESs88 na-egosi na ọ bụ obere mbufụt, ọrịa neoatherosclerosis yiri nke ọgbọ mbụ, mana nyocha ọzọ ka dị mkpa.