内皮祖细胞捕获支架的困惑与希望

药物洗脱支架显著减少了支架内再狭窄的发生,但同时过度的抑制了支架局部的内皮层的自然愈合,影响了其远期疗效。随着内皮祖细胞(endothdial progenitor cells,EPCs)的研究进展, 通过动员外周血EPCs到血管局部并修复损伤内皮成为抗再狭窄的新策略之一,由此理论产生的 EPCs捕获支架正成为一种颇具前景的新型功能化支架。然而目前的EPCs捕获支架仍不成熟,其抗再狭窄功能没有充分体现,但随着对EPCs分化机制和调控的研究逐步深入,以及支架的生物工程化制作工艺的不断改善,EPCs捕获支架作为一种具有加速内皮修复功能的新型支架,在冠心病的介入治疗中将占有重要地位,并将启发人们研制更多的功能化支架。     

可降解涂层支架(EXCEL~(TM))治疗冠心病的疗效和安全性分析

目前经皮冠状动脉介入治疗(PCI)已成为冠心病治疗的主要方法,药物涂层支架虽降低了支架内再狭窄的发生率,但因其植入后血管再内膜化的延迟和炎症反应,使远期支架内血栓事件明显增加[1-2].生物可降解西罗莫司支架可以减少支架药物所致的内皮化延迟和聚合物不降解所致的局部血管壁炎症反应,从而实现预防支架内再狭窄和晚期血栓形成的目的.本文旨在分析EXCEL生物可降解支架治疗冠心病的有效性和安全性.     

内皮祖细胞与支架术后再内皮化的研究进展

冠脉内支架置入术改变了冠心病的治疗格局,然而再狭窄和晚期支架内血栓形成是影响介入治疗疗效及临床应用的主要障碍。内皮祖细胞可以通过再内皮化作用有效地防止支架置入术后再狭窄与晚期血栓的发生,为冠心病的介入治疗提供广阔的应用前景。本文就近几年内皮祖细胞在再内皮化治疗方面的最新进展及存在的问题做一综述。     

缺血性脑卒中患者CAS术后药物治疗的研究进展

近年来国内缺血性脑卒中患者日益增多,颈动脉狭窄为其主要病因之一。颈动脉支架成形术（CAS）为目前治疗颈动脉狭窄的主要方法之一,但术后出现的支架内血栓形成和再狭窄临床处理棘手。研究显示,抗血小板聚集、抗血栓形成及稳定动脉粥样硬化斑块可降低CAS后支架内再狭窄的发生,其中拜阿司匹林、     

药物洗脱支架引起的去内皮化与支架内血栓形成机制的研究新进展

药物洗脱支架(DES)因其显著的低支架再狭窄(ISR)发生率,在动脉粥样硬化性疾病中广泛应用。但是,大量研究发现,置入DES的患者发生支架内血栓形成的风险呈上升趋势。相关研究表明,支架内血栓形成的发生与支架血管内皮损伤紧密相连。损伤的内皮层可引起血小板黏附聚集、支架梁异位或支架内新生动脉粥样硬化形成。因此,本文就DES引起的内皮损伤和支架内血栓形成的具体相关机制以及目前研究的生物可降解支架对防御支架内血栓形成的作用做一简要概述。     

冠状动脉内可吸收金属支架的研究进展

冠状动脉内支架植入是目前广泛应用的冠心病治疗手段,但支架内狭窄和晚期血栓形成影响冠状动脉支架远期疗效和安全性,长期应用抗血小板药物所带来的不良反应以及经济上给患者造成的负担,这些都限制了冠状动脉支架的进一步应用。生物可吸收金属支架具有与裸金属支架相当的支撑力及良好生物相容性,可有效降低再狭窄率和血栓形成,临床应用前景十分广阔。     

解读最新证据:再议双联抗血小板治疗持续时间问题

经皮冠状动脉介入治疗(PCI)已成为冠心病的标准治疗方法之一。其中,支架置入术是冠心病介入治疗的最基本手段。支架置入术后通常要考虑支架内再狭窄和支架内血栓形成两方面的问题。为防止支架内再狭窄,近年临床上普遍采用药物洗脱支架(drug-eluting stent,DES)。然而,药物洗脱支架虽然能降低支架置入术后再狭窄的发生率,但由于药物及涂层本身同时抑制了支架表面的内皮化,从而增加了     

药物洗脱支架(Cypher TM)在非ST段抬高急性冠脉综合征介入治疗中的应用

冠状动脉内支架植入术（PCI）已成为治疗急性冠脉综合征的主要方法,而支架内再狭窄（ISK）仍是多年来困扰冠心病介入治疗领域的顽症之一,尽管加强了抗血小板、抗凝、抗炎等药物治疗,冠脉内支架再狭窄仍居高不下，其发生率高达20％～30％，大大影响了PCI治疗冠心病的疗效，近年来雷帕霉素药物洗脱支架（Cypher^TM）的上市，国内外多个临床试验证明在冠心病患者中应用可以明显降低再狭窄率。我们将雷帕霉素药物涂层支架（Cypher^TM）应用于非ST段抬高急性冠脉综合征的研究观察其治疗的有效性及安全性。     

完全生物可降解支架与再内皮化策略

支架植入术是目前治疗冠心病的主要手段之一,药物支架的不断改进使再狭窄问题得到有效解决,但也存在诸多弊端,最突出的是晚期血栓形成,内皮损伤及内皮化障碍是其主要原因,诸多因素参与了这个过程,如支架涂层药物对正常内皮细胞的非特异性抑制、不可降解的支架材料导致的炎症反应等。由此导致的晚期血栓形成,是支架植入术面临的新矛盾。生物可降解支架,尤其是完全生物可降解支架,有望解决这一难题,是十分有前景的研究方向。     

冠状动脉支架置入术后抗血小板治疗的若干问题

<正> 经皮冠状动脉介入治疗(PcI)已成为冠心病的标准治疗方法之一,其中支架置入术是冠心病介入治疗的最基本手段。药物涂层支架虽然降低了支架置入术后再狭窄发生率,但由于药物及涂层本身同时抑制了支架表面的内皮化,因此,支架置入术后抗血小板治疗成为临床关注的重要问题之一。 1 支架置入术后阿司匹林和氯吡格雷的最佳剂量     

The role of endothelial progenitor cells in restenosis and stent thrombosis after percutaneous coronary intervention

Background After percutaneous coronary intervention (PCI), some patients may suffer from restenosis and stent thrombosis. Many studies suggest that endothelial progenitor cell (EPC) has an important role in preventing restenosis and stent thrombosis. A novel stent which can attract EPC has been designed to provide a better outcome for these problems. Method The data of the present review was obtained by searching PUBMED and other databases (1994-2011) using the key terms of "endothelial progenitor cell", "reendothelialization", "restenosis", "stent thrombosis", and "percutaneous coronary intervention". Result Rapid reendothelialization is essential in preventing restenosis and stent thrombosis. EPC can differentiate into endothelial cell and accelerate the reendothelialization. After numerous preclinical and clinical researches , the correlation between circulating EPCs to restenosis still remains poorly understood. However , many studies have shown the important role of EPC in diminishing the risk of thrombosis following stent implantation. Some pharmacological agents have been reported can increase the number and / or functions of EPC. Recently , CD34+ antibody coated stent has been developed to attract EPC to the healing endothelium , and has showed favorable results. Conclusion EPC has important role in rapid reendothelialization after vascular injury. EPC can prevent stent thrombosis after PCI , however the effects of EPC in preventing restenosis need further investigations. The capturing CD34+ stent is safe and significantly decreases stent thrombosis.     

One‐year clinical outcome in an unselected patient population treated with the Genous™ endothelial progenitor cell capturing stent

Objective : We assessed the 1‐year clinical outcome in a large cohort of unselected patients treated with an endothelial progenitor cell (EPC) capturing coronary stent. Background : The novel EPC capturing stent is coated with CD34+ antibodies that bind circulating EPCs to the stent surface, thereby accelerating endothelialization of the stent struts; it is hypothesized that this may prevent restenosis and stent thrombosis. Methods : A total of 405 unselected patients were treated percutaneously with the EPC capturing stent. The majority of patients had complex lesions with an estimated high risk of restenosis. Results : The primary endpoint defined as the composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) at 1‐year was 13.3%, mainly attributable to TLR which was 10.9%. The occurrence of definite and probable ST was low, 0.5 and 0.7%, respectively. Based on the risk of restenosis, in patients with an estimated high risk of restenosis (n = 249), the composite primary endpoint was 16.1% versus 9.0% in patients with an estimated low risk (n = 155). Moreover, the 1 year clinical outcomes in diabetic patient compared well with the nondiabetic patients. Conclusion : In this single‐center study, the 1‐year clinical follow‐up in a “real‐world” population treated with the EPC capturing stent showed good results. Currently, large randomized studies are conducted to evaluate the long‐term safety and efficacy of this stent. © 2011 Wiley‐Liss, Inc.     

药物支架时代的支架血栓问题

药物洗脱支架具有显著降低支架内再狭窄发生率的作用,显著降低冠状动脉粥样硬化性心脏病病死率及减少血管急性闭塞发生。药物支架时代的支架内血栓一直是冠状动脉介入手术治疗冠状动脉粥样硬化性心脏病的当前研究热点,其一旦发生,导致严重后果。现就当前药物支架时代支架内血栓的问题研究进展进行综述。     

血管支架再内皮化研究进展

目的:介绍血管支架内皮化方面的研究进展。方法:广泛查阅近5年有关血管支架内皮化研究的文献并加以综述。结果:某些细胞因子、化学药物以及促进内皮细胞黏附材料的使用有利于血管支架的内皮化过程。结论:实现血管支架内皮化有望现有支架的生物相容性,恢复血管的正常生理功能,减少经皮冠脉介入术后再狭窄和晚期血栓的发生。     

PCI术后再狭窄的病理生理及其危险因素

经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是一种成熟的冠心病治疗方法,可以很好的实现血运重建,显著的改善患者的生活质量,降低病残率以及死亡率.然而,PCI使患者受益的同时,也会造成血管再狭窄,虽然术后强效抗血小板药物以及药物洗脱支架的引入一定程度上降低了支架植入术后的再狭窄率,但其所致的晚期支架内血栓形成和再狭窄仍然不能忽视.因此,深入了解PCI术后再狭窄及相关影响因素将为PCI术后并发症的治疗提供新的思路和策略.     

Estrogen-Eluting Stents

Coronary stenting is routinely utilized to treat symptomatic obstructive coronary artery disease. However, the efficacy of bare metal coronary stents has been historically limited by restenosis, which is primarily due to excessive neointima formation. Drug-eluting stents (DES) are composed of a stainless steel backbone encompassed by a polymer in which a variety of drugs that inhibit smooth muscle cell proliferation and excessive neointima formation are incorporated. DES have significantly reduced the incidence of restenosis but are also associated with a small (~0.5% per year) but significant risk of late stent thrombosis. In that regard, estrogen-eluting stents have also undergone clinical evaluation in reducing restenosis with the additional potential benefit of enhancing reendothelialization of the stent surface to reduce stent thrombosis. Estrogen directly promotes vasodilatation, enhances endothelial healing, and prevents smooth muscle cell migration and proliferation. Due to these mechanisms, estrogen has been postulated to reduce neointimal hyperplasia without delaying endothelial healing. In animal studies, estrogen treatment was effective in decreasing neointimal hyperplasia after both balloon angioplasty and stenting regardless of the method of drug delivery. The first uncontrolled human study using estrogen-coated stents demonstrated acceptable efficacy in reducing late lumen loss. However, subsequent randomized clinical trials did not show superiority of estrogen-eluting stents over bare metal stents or DES. Further studies are required to determine optimal dose and method of estrogen delivery with coronary stenting and whether this approach will be a viable alternative to the current DES armamentarium.     

Stent thrombosis and drug-eluting stents

Coronary stents have been used for the treatment of patients with coronary artery disease (CAD), and significantly improved procedural safety and are associated with a lower rate of restenosis compared with balloon angioplasty alone. Drug-eluting stents (DES) have been dominant for the treatment of CAD with efficacy in significantly reducing both restenosis and target lesion revascularization. However, late and very late stent thrombosis have become a major concern in DES-implanted arteries compared with those treated with bare-metal stents (BMS). This review focuses on the feature of DES thrombosis and pathological examination and dual antiplatelet therapy for prevention of stent thrombosis.Currently, the incidence of stent thrombosis associated with first-generation and second-generation DES remains unclear in data from real-world cohort registry studies. Further studies of larger multicenter trials would give us insight into the specific mechanisms of stent thrombosis among different generations of DES.     

雌激素与冠心病——通过内皮祖细胞发挥有益作用

内皮祖细胞是血管内皮细胞的前体细胞,目前较多研究提示其在冠心病中的治疗作用。雌激素可能影响冠心病的病理生理过程和预后,但其益处仍未得到肯定。已经有较多证据显示雌激素可通过促进内皮祖细胞的动员、增殖、归巢、分化并减少其凋亡,从而增加内皮修复和血管新生,最终达到减轻心脏缺血性损伤,改善心脏功能的作用。由于内皮祖细胞的长期作用仍缺乏研究,而通过内皮祖细胞对冠心病发挥影响也很可能仅是雌激素的部分作用,雌激素在冠心病的预防和治疗方面的益处依然需要更多的研究以证实。     

冠心病患者支架置入术后再狭窄原因的临床研究

目的通过对经皮冠状动脉介入术后复查冠状动脉造影患者的回顾性分析,研究引起支架内再狭窄(ISR)的可能原因。方法入选我院2008—2011年所有复查造影的冠心病支架治疗患者210例,平均年龄(68.9±7.8)岁;男125例,女85例,将其分成支架内再狭窄组和无再狭窄组,分析两组间可能导致支架内再狭窄的因素。结果 210例患者共置入352枚支架,其中有37枚支架发生再狭窄(支架内再狭窄定义为随访时造影提示支架内管腔内径损失≥50%)。分析两组临床资料特征及支架长度、直径,是否为药物涂层支架等因素;支架内再狭窄组及无再狭窄组在脂蛋白(a)、支架长度、和药物/非药物支架方面有显著差异(P<0.05)。Cox比例风险回归模型显示仅支架长度(P=0.007)、直径(P=0.022)和药物/非药物支架(P=0.036)为冠心病介入患者发生ISR的预测因子。结论冠状动脉支架置入后发生再狭窄的主要原因为支架长度、直径及是否为药物支架。     

雷帕霉素抑制冠状动脉支架置入术后血管再内皮化相关机制进展

雷帕霉素是药物涂层支架最常用的载入药物,在抑制内膜增生的同时,也抑制了内皮细胞的功能,延迟损伤血管再内皮化,易引发支架内血栓形成。雷帕霉素抑制再内皮化的作用机制较为复杂,对其机制的研究是解决雷帕霉素不良作用的关键,也是近年来的研究热点。文章从内皮细胞功能、内皮细胞前体细胞、内皮细胞凋亡三个方面,就近年来对雷帕霉素延迟血管再内皮化作用机制的研究进展作一综述。