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Marta Francesca Brancati. Si kastaba ha ahaatee, inkasta oo soo bandhigida jiilka labaad ee DES ay u muuqato in ay dhexdhexaadisay ifafaale marka la barbardhigo jiilka kowaad ee DES, walaac halis ah ayaa weli ah oo ku saabsan dhibaatooyinka dambe ee suurtogalka ah ee tallaalka stent, sida stent thrombosis (ST) iyo dib u soo celinta stent.Stenosis(ISR) Daraasadaha kiliinikada iyo taariikhda labadaba ee DESs waxay muujiyeen caddaynta koritaanka neointimal joogtada ah inta lagu jiro daba-galka muddada-dheer, dhacdo loo yaqaan "qabsashada dambe" ifafaale. bogsiinta weelka teendhada;waxaa inta badan loo isticmaalaa si loo dhamaystiro ogaanshaha cudurka angiography ee wadnaha iyo wadista hababka dhexgalka.Intracoronary indhaha isku xirnaanta hadda waxaa loo arkaa farsamada sawirka ugu horumarsan.Marka la barbar dhigo ultrasound intravascular, waxay bixisaa xal ka wanaagsan (ugu yaraan> 10 jeer), jidaynayey si faahfaahsan qaab-dhismeedka dusha derbiga markabka. BMS iyo DES. Sidaa darteed, neo-atherosclerosis waxay noqotay tuhmanaha aasaasiga ah ee pathogenesis of stent failure. Kelmado furaha: stent halbowleyaasha, stent thrombosis, restenosis, neoatherosclerosis
Dhexdhexaadinta wadnaha ee xididdada ah (PCI) oo leh stent implantation waa habka ugu badan ee loo isticmaalo daaweynta cudurka halbowlaha wadnaha ee calaamadaha, farsamaduna way sii socotaa si ay u kobciso., walaac halis ah ayaa weli ah.2-5
Haddii ST ay tahay dhacdo masiibo ah oo suurtagal ah, aqoonsiga in ISR uu yahay cudur aan fiicneyn ayaa dhowaan lagu loolamay caddaynta xanuunka wadnaha ee degdega ah (ACS) ee bukaannada ISR.
Maanta, tomography intracoronary optical coherence tomography (OCT) 6-9 waxaa loo tixgeliyaa farsamada sawirka casriga ah ee hadda jirta, oo bixisa xal ka fiican marka loo eego ultrasound intravascular (IVUS).
1964kii, Charles Theodore Dotter iyo Melvin P Judkins ayaa ku tilmaamay angioplasty kii ugu horreeyayWaxay ahayd daawaynta kacaanka laakiin waxay lahayd cilladaha xidhitaanka weelka degdega ah iyo restenosis.13 Tani waxay keentay in la ogaado xinjirowga wadnaha: Puel iyo Sigwart waxay geeyeen stent-kii ugu horreeyay 1986, iyagoo siinaya stent si looga hortago xiritaanka ba'an iyo dib-u-soo-celinta systolic ee goor dambe, laakiin xinjiraha hore waxay ka hortageen barar ba'an. tijaabooyinka, Belgian-Dutch Stent Trial 15 iyo Stent Restenosis Study 16, waxay ku doodeen badbaadada stenting oo leh daawaynta antiplatelet dual antiplatelet (DAPT) iyo / ama farsamooyinka geynta habboon.
Si kastaba ha ahaatee, dhibaatada iatrogenic in-stent neointimal hyperplasia ka dib meelaynta BMS ayaa si degdeg ah loo aqoonsaday, taasoo keentay in ISR ee 20%-30% ee nabarrada la daweeyay. 2001, DES ayaa la soo bandhigay19 si loo yareeyo baahida loo qabo restenosis iyo dib u soo celinta. 2005, 80%-90% dhammaan PCI-yada waxaa la socday DES.
Wax walbaa waxay leeyihiin cilladahooda, iyo tan iyo 2005, welwelka ku saabsan badbaadada "jiilka kowaad" DES ayaa kor u kacay, iyo jiilka cusub sida 20,21 ayaa la sameeyay oo la soo bandhigay.
BMS waa tuubo silig khafiif ah mesh. Ka dib markii ugu horeysay ee waayo-aragnimo ah ee "Darbiga" Buur, Gianturco-Roubin mount iyo Palmaz-Schatz Mount, BMS badan oo kala duwan ayaa hadda la heli karaa.
Saddex naqshadood oo kala duwan ayaa suurtagal ah: gariiradda, shabagga tuubada iyo tuubada godadsan. Naqshadaynta gariiradda waxay ka kooban tahay fiilooyinka birta ah ama xariijimaha loo sameeyay qaab gariirad wareeg ah;Naqshadaynta mesh tuber waxay ka kooban tahay fiilooyinka la isku duubay shabag si ay u sameeyaan tuubo;Naqshadeynta tube-jeexan waxay ka kooban tahay tuubooyin bir ah oo la gooyey laser. Qalabkani waxay ku kala duwan yihiin halabuurka (birta aan fiicnayn, nichrome, kobalt chrome), naqshadaynta qaabdhismeedka (qaababka strut kala duwan iyo ballacyada, dhexroorka iyo dhererka, xoogga shucaaca, shucaaca) iyo hababka bixinta (is-ballaadhinta ama buufin-ballaarinta) .
Guud ahaan, BMS-ga cusub waxa uu ka kooban yahay daawaha cobalt-chromium, taas oo keenta in struts khafiif ah oo la hagaajiyey navigability, ilaalinta xoogga farsamada.
Waxay ka kooban yihiin qalab bir ah oo bir ah (sida caadiga ah birta aan lahayn) oo lagu dahaadhay polymer ka soo horjeeda daaweynta ka hortagga faafinta iyo/ama ka hortagga bararka.
Sirolimus (oo sidoo kale loo yaqaan rapamycin) ayaa markii hore loo qaabeeyey sida wakiilka antifungal. Farsamaynta ficilku waxay ka soo baxdaa xannibaadda horumarka wareegga unugyada iyada oo xannibaysa isbeddelka marxaladda G1 ee marxaladda S iyo joojinta samaynta neointima. Sannadkii 2001, waayo-aragnimada "qofka ugu horreeya ee bani'aadamka" ee SES waxay muujisay natiijooyin rajo leh, taas oo horseedaysa horumarinta tijaabada ah ee I3. nty afar
Paclitaxel ayaa markii hore loo ogolaaday kansarka ugxan-sidaha, laakiin sifooyinka cytostatic ee awoodda leh - daroogada ayaa dejisa microtubules inta lagu jiro mitosis, waxay keenaysaa in la xiro wareegga unugyada waxayna joojisaa sameynta neointimal - waxay ka dhigtaa xarunta Taxus Express PES. TaxUS V iyo VI tijaabooyin waxay muujiyeen waxtarka muddada dheer ee PES. soo bandhigay madal bir ah oo si sahlan loo gaarsiinayo.
Caddaynta gabagabada ah ee laba dib-u-eegis habaysan iyo falanqayn-meta ayaa soo jeedinaysa in SES ay faa'iido ka leedahay PES sababtoo ah heerarka hoose ee ISR iyo maraakiibta dib-u-soo-celinta (TVR), iyo sidoo kale isbeddelka kor u kaca wadnaxanuun myocardial (AMI) ee kooxda PES.27,28
Aaladaha jiilka labaad waxay hoos u dhigeen dhumucda strut-ga, hagaajinta dabacsanaanta/ bixinta, polymer bioocompatibility/profile elution profiles oo la xoojiyey, iyo dib-u-soo-celinta kinetics-ka wanaagsan.
Taxus Elements waa horumar dheeraad ah oo leh polymer gaar ah oo loogu talagalay in lagu kordhiyo sii-deynta hore iyo nidaamka cusub ee platinum-chromium strut kaas oo bixiya struts khafiif ah iyo radiopacity la xoojiyay.The PERSEUS trial 29 ayaa xusay natiijooyin isku mid ah inta u dhaxaysa Element iyo Taxus Express ilaa bilaha 12. Si kastaba ha ahaatee, tijaabooyinka isbarbardhigga walxaha jaalaha ah iyo kuwa kale ee jiilka labaad ee DES waa kuwo la mid ah.
Zotarolimus-eluting stent (ZES) Endeavor wuxuu ku salaysan yahay madal ka xoog badan kobalt-chromium stent oo leh dabacsanaan sare iyo cabbirka stent stent yar. Eluted inta lagu guda jiro marxaladda dhaawaca hore, oo ay ku xigto dayactirka halbowlaha. Si kastaba ha ahaatee, tijaabada PROTECT waxay ku guuldareysatay inay muujiso farqiga u dhexeeya heerarka ST ee u dhexeeya Endeavor iyo Cypher stent.32
Endeavor Resolute waa nooca la wanaajiyey ee Endeavor stent oo leh polymer cusub oo saddex-lakab ah. The newer Resolute Integrity (mararka qaarkood loo yaqaan DES-jiilka saddexaad) waxay ku salaysan tahay madal cusub oo leh awood gaarsiinta sare (the Integrity BMS platform), iyo novel ah, more biocompatible biocompatible three-Layer polymers, the most horp0 the anti-inflammatory drugs over 6 days ago aring Resolute with Xience V (everolimus-eluting stent [EES]) waxay muujisay hoos-u-dhac la'aanta nidaamka xallinta marka loo eego dhimashada iyo dhaawaca bartilmaameedka.33,34
Everolimus, oo ah derivative of sirolimus, sidoo kale waa xakameynta wareegga gacanta ee loo isticmaalo horumarinta Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium platform) EES. Tijaabada SPIRIT 35-37 waxay muujisay waxqabad wanaagsan waxayna hoos u dhigtay MACE oo leh Xience V marka la barbar dhigo PES, halka ECELLES-ga la soo bandhigay ee aan la soo bandhigin 9 bilood ka dib. dhacdooyinka al 12 bilood.
EPCs waa qayb ka mid ah unugyada wareega ee ku lug leh vascular homeostasis iyo dayactirka endothelial. Kobcinta EPCs ee goobta dhaawaca xididada xididada waxay kor u qaadi doontaa dib-u-soo-celinta hore ee endothelialization, taas oo suurtogal ah in la yareeyo khatarta ST.EPC bayooloji ee isku daygii ugu horreeyay ee beerta naqshadeynta stent waa CD34-ka-hortagga-daboolan ee Genous-ka-soo-celinta dib-u-celinta dib-u-kicinta EPC. Lialization.In kasta oo daraasadihii hore ay ahaayeen kuwo dhiirigelinaya, caddaynta dhow waxay tilmaamaysaa heerarka sare ee TVR.40
Iyadoo la tixgelinayo saameynta waxyeellada leh ee dib-u-celinta dib-u-celinta polymer-ka, taas oo la xiriirta khatarta ST, polymers bioabsorbable waxay bixiyaan faa'iidooyinka DES, ka fogaanshaha welwelka muddada dheer ee ku saabsan adkaysiga polymer. Ilaa hadda, nidaamyada bioabsorbable ee kala duwan ayaa la ansixiyay (tusaale Nobori iyo Biomatrix, biolimus eluting stent, Synergy, EES, EES, SES, supporting the long term)
Maaddooyinka bioabsorbable waxay leeyihiin faa'iido fikradeed oo ah bilowga bixinta taageerada farsamada marka dib-u-celinta laastikada la tixgeliyo oo la yareeyo khatarta muddada dheer ee la xidhiidha birta birta ee jira. Tiknoolajiyada cusub ayaa horseeday horumarinta polymers-ku-salaysan lactic acid (poly-l-lactic acid [PLLA]), laakiin habab badan oo stent ah ayaa ku jira horumarinta, inkastoo la go'aaminayo dheelitirka ugu habboon ee u dhexeeya caqabadda badbaadada daroogada iyo hoos-u-dhigga ABSO. mus-eluting PLLA stent.43 Jiilka labaad ee Absorb stent dib u eegis wuxuu ahaa horumar ka badan kii hore oo leh 2-sano oo wanaagsan la socosho. la caddeeyey.
Dhiig-xinjirow ku dhaca BMS iyo DES labaduba waxay leeyihiin natiijooyin caafimaad oo liita. Diiwaanka bukaannada qaata tallaalka DES, 47 24% kiisaska ST waxay keeneen dhimasho, 60% MI aan dhimasho ahayn, iyo 7% angina aan degganayn.
ST Advanced ST waxay leedahay natiijooyin caafimaad darro oo suurtagal ah. Daraasadda BASKET-LATE, 6 ilaa 18 bilood ka dib meelaynta stent, heerarka dhimashada wadnaha iyo kuwa aan dhimashada ahayn MI waxay ka sarreeyaan kooxda DES marka loo eego kooxda BMS (4.9% iyo 1.3%, siday u kala horreeyaan). 4 sano oo dabagal ah, SES (0.6% vs 0%, p=0.025) iyo PES (0.7%) waxay kordhiyeen dhacdooyinka ST goor dambe marka la barbar dhigo BMS 0.2%, p=0.028) oo la xidhiidha korodhka 15% ee aan muhiimka ahayn (Lasoco 9 bilood ilaa 3 sano).
Diiwaangelin badan, tijaabooyin kala duwan, iyo falanqayn-meta-falanqeeyayaal ayaa baadhay khatarta qaraabada ah ee ST ka dib BMS iyo DES implantation waxayna soo sheegeen natiijooyin iska soo horjeeda.Diiwaan gelinta bukaanada 6,906 ee qaata BMS ama DES, ma jiraan wax kala duwanaansho ah natiijooyinka kiliinikada ama heerarka ST inta lagu jiro 1-sano dabagal ah. %/sannadka marka la barbar dhigo BMS.49 Falanqaynta meta ee tijaabooyinka isbarbardhigga SES ama PES ee BMS waxay muujisay khatarta sii kordheysa ee dhimashada iyo MI ee jiilka kowaad ee DES marka la barbar dhigo BMS, 21 iyo falanqaynta kale ee 4,545 bukaannada loo kala soocay SES ama Ma jirin farqi u dhexeeya dhacdooyinka ST ee u dhexeeya PES iyo BMS ee kor u kaca ee daraasadaha kale ee cilmi-baarista ee MIST ayaa muujiyay kororka sannadaha 4. helitaanka jiilka kowaad ee DES ka dib joojinta DAPT.51
Marka la eego caddaymaha is khilaafaya, dhowr falanqayn oo la isku daray iyo falanqayn-meta-falanqaynta ayaa si wada jir ah u go'aamiyay in jiilka kowaad ee DES iyo BMS aysan si weyn uga duwanayn khatarta dhimashada ama MI, laakiin SES iyo PES waxay lahaayeen khatar kordhaysa oo ah ST aad u horumarsan marka la barbar dhigo BMS.Si dib loogu eego caddaynta la heli karo, Maamulka Cuntada iyo Dawooyinka ee Maraykanka (FDA) waxay magacawday guddi khabiir53 kaas oo soo saaray bayaan ay ku qirayaan in jiilka kowaad ee DES ay waxtar u leeyihiin calaamadaha ku-yaalla iyo in khatarta ST ee aad u horumarsan ay tahay mid yar laakiin yar.Kor u kac wayn
Sida hore loo soo sheegay, jiilka labaad ee DES oo leh sifooyin naqshad sare leh ayaa la sameeyay.CoCr-EESs ayaa maray daraasadaha kiliinikada ee ugu ballaadhan.In a meta-analysis by Baber et al,54 oo ay ku jiraan bukaanada 17,101, CoCr-EES waxay si weyn hoos ugu dhigtay ST iyo MI-da la hubo marka la barbar dhigo PES, SES, iyo ZES ka dib markii 21 bilood ee 7 ee Paalfini. CoCr-EES waxay si aad ah hoos ugu dhacday goor hore, daahday, 1- iyo 2-sano oo qeexan ST marka la barbar dhigo kuwa kale ee la isku geeyay DES.55 Daraasadaha dhabta ah ee aduunka ayaa muujiyay hoos u dhac ku yimid khatarta ST ee CoCr-EES marka la barbar dhigo jiilka kowaad DES.56
Re-ZES ayaa la barbardhigay CoCr-EES ee RESOLUTE-AC iyo tijaabooyinka TWENTE.33,57 Ma jirin farqi weyn oo u dhexeeya dhacdooyinka dhimashada, wadnaxanuun myocardial, ama ST qeexan oo u dhexeeya labada stents.
Shabakadda falanqaynta-falanqaynta ee bukaannada 50,844 oo ay ku jiraan 49 RCTs,58CoCr-EES ayaa lala xiriiriyay dhacdo aad u hooseeysa ee ST qeexan marka loo eego BMS, natiijada aan lagu arkin DES kale;Hoos-u-dhimista ma ahayn oo kaliya Hore iyo maalmaha 30 (saamiga isbeddelka [OR] 0.21, 95% kalsoonida kalsoonida [CI] 0.11-0.42) iyo sidoo kale sanadka 1 (OR 0.27, 95% CI 0.08-0.74) iyo 2 sano (OR 0.35-ES0.9.9) iyo ZES, CoCr-EES waxay la xidhiidhay dhacdo hoose oo ST ah 1 sano.
Hore ee ST waxay la xiriirtaa arrimo kala duwan. Qaab-dhismeedka xuubka hoose ee xuubka iyo culeyska xinjirowga ayaa u muuqda inay saameynayaan natiijooyinka PCI ka dib;59 Dhexdhexaadin qoto dheer oo ay ugu wacan tahay soo-dhaca necrotic core (NC), ilmada dhexdhexaadka ah ee dhererka stent-ka, kala-baxa labaad ee leh haraaga haraaga, ama cidhiidhiga weyn ee hoos u dhigista stenting ugu fiican, soo-jeedin aan dhamaystirnayn, iyo ballaarinta aan dhamaystirnayn60 Nidaamka daawaynta ee daawooyinka antiplatelet si weyn uma saameeyaan dhacdooyinka degdega ah ee DAPT. Isbarbardhigga BMS iyo Heerarka DES waxay la mid ahaayeen (<1%).61 Haddaba, horraantii ST waxay u muuqataa inay ugu horrayn la xiriirto nabarrada daweynta ee hoose iyo arrimaha qalliinka.
Maanta, diiradda gaarka ah waxay ku saabsan tahay daaha / aad u daahay ST. Haddii arrimaha habraaca iyo farsamada ay u muuqdaan inay door weyn ka ciyaaraan horumarinta ST ba'an iyo subacute , habka dib u dhaca dhacdooyinka thrombotic waxay u muuqataa mid aad u adag.Waxaa la soo jeediyay in sifooyinka bukaan-socodka qaarkood ay noqon karaan arrimo halis u ah ST horumarsan oo aad u sarreeya: sonkorowga, ACS inta lagu jiro qaliinka bilowga ah, kelyaha, da'da sare ee MS, hoos u dhac ku yimaada maalmaha hore ee xanuunka B. ES, doorsoomayaasha habraaca, sida cabbirka yar yar ee weelka, kala-soocida, cudurada polyvascular, calcification, wadarta guud ee occlusion, stent dheer, waxay u muuqdaan inay la xiriiraan khatarta sare ee ST.62,63 Jawaab-celinta ku filan ee daaweynta antiplatelet waa arrin halis weyn u ah xinjirowga DES horumarsan 51. (gaar ahaan caabbinta clopidogrel), iyo kor u qaadida waddooyinka kale ee firfircoonida platelet.In-stent neoatherosclerosis waxaa loo tixgeliyaa hab muhiim ah oo ah fashilka dambe ee DE, oo ay ku jiraan ST64 (qaybta "in-stent neoatherosclerosis"). dawooyinka iyo madal daroogada-eluting ah oo leh saameyno kala duwan oo ku saabsan bogsashada iyo shaqada endothelial, oo leh khatarta xinjirowga dambe ee 65 Cilmi-baarisyada cilmi-nafsiga waxay soo jeedinayaan in polymers-ka joogtada ah ee jiilka kowaad ee DES ay gacan ka geysan karaan caabuqa daba-dheeraada, kaydinta fibrin ee joogtada ah, bogsashada endothelial liidata, iyo khatarta korodhka khatarta ah ee xinjirowga .3 Late hypersensitivity to postSTmani balaadhinta aneurysm ee qaybta stent oo leh dareen-celin xasaasiyadeed oo maxalli ah oo ka kooban T lymphocytes iyo eosinophils;Natiijooyinkani waxay ka tarjumayaan saameynta polymers-ka aan la isticmaali karin.67 Stent malapposition waxaa laga yaabaa inay sabab u tahay balaadhinta stent-ka hoose ama waxay dhacdaa bilo ka dib PCI.In kasta oo cilladaha habraaca ay tahay arrin halis u ah ST ba'an iyo subacute, muhiimadda bukaan-socodka ee la helay cillad-xumada stent waxay ku xirnaan kartaa dib-u-qaabaynta halbowlaha qallafsan ama bogsashada dawooyinka.
Saamaynta ilaalinta ee jiilka labaad ee DES waxaa ku jiri kara degdeg badan oo degdeg ah, iyo sidoo kale kala duwanaanshaha daawaynta stent iyo qaab-dhismeedka, dhumucda strut, sifooyinka polymer, iyo nooca daroogada ka hortagga proliferative, qiyaasta, iyo kinetics.
Marka loo eego CoCr-EES, khafiif ah (81 µm) kobalt-chromium stent struts, antithrombotic fluoropolymers antithrombotic, polymer hoose, iyo loading daroogada waxay gacan ka geysan karaan hoos u dhac ku yimid ST. Daraasadaha tijaabada ah ayaa muujiyay in xinjirowga iyo dhigista platelet ee stents fluoropolymer-dahaarka leh ay si aad ah uga hooseeyaan kuwa kale ee WES. waxbarasho dheeraad ah.
Istaraatijiyadaha halbowlaha ah waxay hagaajiyaan heerka guusha qalliinka ee waxqabadyada halbowlaha marka la barbar dhigo dhaqameed dhaqameed ee transluminal coronary angioplasty (PTCA), kaas oo leh dhibaatooyin farsamo (xididdada xididdada, kala-baxa, iwm.) iyo heerarka sare ee restenosis (ilaa 40%-50% kiisaska).Dabayaaqadii 1990-aadkii, ku dhawaad ​​70% PCI-yada waxaa lagu sameeyay BMS la geliyo.70
Si kastaba ha ahaatee, inkastoo horumarinta tignoolajiyada, farsamooyinka, iyo daaweynta daaweynta, khatarta dib-u-soo-kabashada ka dib markii lagu dhejiyo BMS waa qiyaastii 20%, oo leh> 40% kooxo-hoosaadyo gaar ah.71 Guud ahaan, cilmi-baaris caafimaad ayaa muujisay in dib-u-soo-celinta ka dib markii BMS la geliyo, oo la mid ah kuwa lagu arkay PTCA-ga caadiga ah, ugu sarreysa bilaha 3-6 waxayna xalliyaan 1 sano ka dib.
DES waxay sii yaraynaysaa dhacdooyinka ISR,73 inkasta oo dhimistani ay ku xiran tahay angiography iyo goobta bukaan-socodka. Daahan polymer-ka ah ee DES wuxuu sii daayaa wakiilada anti-bararka iyo ka-hortagga proliferative, waxay joojisaa sameynta neointima, waxayna dib u dhigtaa habka dayactirka xididdada bilaha ilaa sanadaha . waxbarashada.75
Dhaawaca xididdada dhiigga inta lagu jiro PCI waxay soo saartaa nidaam adag oo barar iyo hagaajin ah muddo gaaban (toddobaadyo ilaa bilo), taasoo keenta endothelialization iyo caymiska neointimal.Sida laga soo xigtay indha-indheynta histopathological, hyperplasia neointimal (BMS iyo DES) ka dib markii stent implantation ahaa inta badan ka kooban proliferative smooth muruqa unugyada matrix proglycan-arich.
Sidaa daraadeed, neointimal hyperplasia waxay u taagan tahay habka dayactirka ee ku lug leh xinjirowga iyo caabuqa iyo sidoo kale unugyada keena kororka unugyada muruqa ee siman iyo samaynta matrixka ka baxsan. Isla markiiba ka dib PCI, platelets iyo fibrin dhigaalka derbiga markabka iyo qorista leukocytes iyada oo loo marayo taxane ah molecules adhesion cell. iyo platelet glycoprotein Ibα 53 ama fibrinogen oo ku xidhan platelet glycoprotein IIb/IIIa.76,77
Sida laga soo xigtay xogta soo baxday, unugyada dhuuxa lafta ka soo baxa ayaa ku lug leh jawaabaha xididada iyo hababka dayactirka. Abaabulka EPC-yada laga soo bilaabo dhuuxa lafta ee dhiiga durugsan waxay kor u qaadeysaa dib u soo kabashada endothelial iyo neovascularization ka dib. dadka go'an ee EPC-yada;Daraasado dheeraad ah ayaa muujiyay in antigen-ka dusha sare ee CD34 uu si dhab ah u aqoonsanayo unugyada tarma ee dhuuxa lafta aan kala sooc lahayn oo awood u leh inay u kala soocaan EPC-yada iyo SMPC-yada. Kala-duwanaanta unugyada CD34-positive ee EPC ama SMPC waxay ku xiran tahay deegaanka deegaanka;Xaaladaha ischaemic waxay keenaan kala duwanaansho dhinaca phenotype EPC si kor loogu qaado dib-u-dhiska, halka xaaladaha caabuqa ay keenaan kala duwanaansho dhinaca phenotype SMPC si kor loogu qaado faafinta neointimal.79
Cudurka macaanku wuxuu kordhiyaa halista ISR 30%-50% ka dib markii BMS la geliyo, 80 iyo dhacdooyinka sare ee restenosis ee bukaanada sonkorowga qaba marka la barbar dhigo bukaanada aan sonkorowga qabin ayaa sidoo kale ku sii jiray xilligii DES. Hababka ka hooseeya indha-indhayntani waxay u badan tahay inay yihiin kuwo badan, oo ku lug leh nidaamka (tusaale, kala duwanaanshaha jawaab-celinta caabuqa), dhexroorka jirrada yaryar, iwm. ly Khatarta ISR.70
Dhexroorka markabka iyo dhererka dhaawaca ayaa si madax banaan u saameeyay dhacdooyinka ISR, oo leh dhexroor yar / nabarro dhaadheer ayaa si weyn u kordhinaya heerarka restenosis marka la barbar dhigo dhexroor weyn / nabarrada gaaban.71
Jiilka kowaad ee aaladaha stent waxay muujiyeen stent stent oo ka sii dhumuc weyn iyo heerar sare oo ISR ah marka la barbar dhigo aaladaha stent ee jiilka labaad oo leh qaab-dhismeed khafiif ah.
Intaa waxaa dheer, dhacdooyinka restenosis waxay la xiriiraan dhererka stent, oo leh dhererka stent> 35 mm ku dhawaad ​​laba jeer inta ay dheer yihiin kuwa <20 mm. Dhererka ugu dambeeya ee ugu yar ee dhexroorka lumen ayaa sidoo kale door muhiim ah ka ciyaaray: dhexroorka ugu yar ee ugu hooseeya ee lumen ayaa saadaaliyay khatarta sii kordheysa ee restenosis.81,82
Dhaqan ahaan, hyperplasia intimal ka dib ku dhejinta BMS waxaa loo arkaa mid deggan, iyadoo ugu sarreysa inta u dhaxaysa 6 bilood iyo 1 sano, oo ay ku xigto muddo gaaban oo daahsan. Horaantii ugu sarreysay ee korriinka hoose ayaa hore loo soo sheegay, oo ay ku xigto dib-u-dhac ku-meel-gaar ah oo leh lumen ballaaran dhowr sano ka dib markii la geliyo stent; , Daraasado lagu sameeyay dabagal dheer oo dheer ayaa muujiyay jawaab celin saddex geesood ah ka dib meelaynta BMS, oo leh dib-u-soo-celin hore, dib-u-dhac dhexdhexaad ah, iyo lumen restenosis dambe.84
Xilligii DES, korriinka dambe ee neointimal ayaa markii hore la muujiyay ka dib markii lagu dhejiyay SES ama PES ee noocyada xayawaanka.85 Daraasado dhowr ah oo IVUS ah ayaa muujiyay hoos u dhac hore oo korriin ah oo ay ku xigto wakhti dambe oo ka dib markii la rakibay SES ama PES, laga yaabo inay sabab u tahay habka caabuqa ee socda.86
In kasta oo "xasilooni" dhaqan ahaan loo nisbeeyo ISR, qiyaastii saddex meelood meel bukaannada BMS ISR waxay horumariyaan ACS.4
Waxaa jira caddayn sii kordheysa oo ah in bararka dabadheeraad ah iyo / ama ku filnaanta endothelial ay keento neoatherosclerosis horumarsan gudaha BMS iyo DES (inta badan jiilka koowaad ee DES), taas oo noqon karta hab muhiim u ah ISR horumarsan ama horumarsan ST.Inoue et al.87 ayaa sheegay natiijooyinka taariikhiga ah ee laga soo qaaday shaybaarrada meydka ka dib markii la geliyo stent ee Palmaz-Schatz, taas oo soo jeedinaysa in bararka peri-stent uu dardargelin karo isbeddellada cusub ee atherosclerotic ee gudaha stent. Daraasadaha kale10 ayaa muujiyay in unugyada restenotic ee gudaha BMS, ka badan 5 sano, ay ka kooban yihiin kuwa cusub oo soo baxaya atherosclerosis-, oo aan lahayn caabuq;shaybaarada laga soo qaaday kiisaska ACS waxay muujinayaan huurada nugul ee caadiga ah ee xididada halbowlayaasha asaliga ah ee hiddaha taariikhiga ah ee xannibaadda leh makrophages xumbo iyo kolestaroolka kolesteroolka. Intaa waxaa dheer, marka la barbardhigo BMS iyo DES, farqi weyn oo u dhexeeya wakhtiga horumarinta atherosclerosis cusub ayaa la xusay. ions waxay dhaceen 2 sano ka dib waxayna ku sii jireen helitaan naadir ah ilaa sanadaha 4. Intaa waxaa dheer, DES stenting ee nabarrada aan xasilloonayn sida fibroatherosclerosis (TCFA) khafiif ah ama dillaaca degdega ah ayaa leh waqti gaaban horumarinta marka la barbardhigo BMS. Sidaa darteed, neoatherosclerosis waxay u muuqataa mid aad u badan oo ku dhacda horraantii jiilka kowaad ee DES marka loo eego BMS.
Saamaynta jiilka labaad ee DES ama DES ee horumarka ayaa weli ah in la barto;inkastoo qaar ka mid ah indha-indhaynta jira ee jiilka labaad ee DESs88 ay soo jeedinayaan barar yar, dhacdooyinka neoatherosclerosis waxay la mid yihiin jiilka kowaad, laakiin cilmi-baaris dheeraad ah ayaa weli loo baahan yahay.