药物洗脱支架年代支架内血栓再评估

药物洗脱支架(DES)的应用,显著降低冠心病介入治疗术后的再狭窄发生率,并改善了患者的预后.本文对DES治疗的安全性与效价比、持续性、有效性等进行评估,针对现有DES可能面临的安全性顾虑,提出应进一步改进现有DES的方向,积极开发第二代DES,提高和完善冠心病介入治疗的效果.     

The drug-eluting stent information gap

Drug-eluting stents are quickly replacing bare-metal stents as the arterial revascularization device of choice. Because nearly all the information we have about patient outcomes with drug-eluting stents is from trials designed for US Food and Drug Administration approval, we are missing some of the information critical to a more comprehensive understanding of how these new devices will perform at the population level.     

Management of drug-eluting stent restenosis

In-stent restenosis has been a longstanding problem after percutaneous coronary intervention. The introduction of the drug-eluting stent (DES) successfully reduced the rate of restenosis; however, it is not completely diminished. Although restenosis occurs less frequently compared to the bare-metal stent (BMS), DES restenosis remains a familiar problem due to the increasing total number of implanted DESs as well as the targeting of more complex lesions. In addition, worse outcomes after repeat revascularization compared to BMS restenosis are reported in DES restenosis. Management of DES restenosis is an emerging issue, which requires careful evaluation of the restenosed lesion, together with cautious determination of therapeutic strategy. In this review, available repeat revascularization procedures for DES restenosis as well as possible impacting factors on the outcomes are discussed.     

Late stent thrombosis thirteen months after drug-eluting stent implantation

We present a case of a very late stent thrombosis which occurred 13 months after drug-eluting stent (DES) implantation. The DES was off-label used in a high-risk patient and was followed by 12-month clopidogrel administration. One month after the drug discontinuation the stent thrombosis occurred, resulting in acute myocardial infarction. The patient was successfully treated with balloon coronary angioplasty and was advised to use clopidogrel indefinitely.     

药物洗脱支架的希望与挑战

进入21世纪以来,由于药物洗脱支架（drugeluting stent,DES）的诞生及其显降低支架内再狭窄的惊人效果再次掀起经皮冠状动脉介入治疗（PCI）的浪潮,DES将“药物治疗和器械治疗合二为一”,既是大胆创举,更是人类智慧和科技高度发达的完美结合。已经获得的研究结果中证实了DES的临床应用是冠心病介入治疗学的一个重要突破并再次将PCI推向新的时代,成为第三个里程碑。     

药物涂层支架的早期临床疗效观察

目的 :评价药物涂层冠状动脉内支架的早期疗效。方法 :2 0 0 2年 9月～ 2 0 0 3年 4月 10 2例冠心病患者接受药物涂层冠状动脉内支架术治疗 (14 1枚 ,药物支架组 ) ,随机选择同期 10 2例接受普通、非药物涂层支架治疗 (15 8枚 ,裸支架组 ) ,比较两组支架置入情况及早期临床事件发生率。结果 :两组手术成功率相似 (10 0 %∶99.0 % ,P >0 .0 5 )。平均随访 (4 .9± 3.3)个月 ,随访率 87.2 % ,药物支架组心绞痛复发率显著低于裸支架组(7.8%∶2 3.5 % ,P <0 .0 1)。结论 :冠心病患者应用药物涂层支架治疗早期临床效果优于普通标准支架     

How to approach drug-eluting stent restenosis

Drug-eluting stents (DES) have been a major advance in percutaneous coronary intervention reducing restenosis and repeat revascularization. The application of DES to the treatment of complex lesion and patient subsets has resulted in significant rates of DES restenosis or failure. Though predominantly focal, substantial rates of non-focal DES restenosis are being observed. Non-focal disease most likely represents a resistant process that will remain a therapeutic challenge. An understanding of the causative mechanical and biological factors is essential for the prevention and treatment of DES restenosis. Robust data relating to the treatment efficacy for this problem is lacking. At present, repeat DES or vascular brachytherapy appear to the best available options. Evidence from randomized controlled trials and large registries is required to establish a formal treatment approach. We provide guidelines based on current available evidence.     

Simultaneous multivessel acute drug-eluting stent thrombosis

Stent thrombosis (ST) in the era of bare metal stents (BMS) using high-pressure stent deployment and combined anti-platelet therapy is an uncommon but feared complication. There is concern for an elevated risk of stent thrombosis (ST) with drug-eluting stents (DES). We describe a case of simultaneous multivessel drug-eluting stent thrombosis 8 h after deployment of paclitaxel-eluting stents in the right coronary (RCA) and left anterior descending (LAD) arteries.     

Recurrent very late drug-eluting stent thrombosis

In-stent thrombosis is a severe and potentially fatal event. The incidence of this pathological process does not differ significantly after implantation of either bare metal or drug-eluting stents (DESs) in the first month after intervention, but stent thrombosis (ST) continues to occur over a long period of time after implantation of DESs, a phenomenon known as late and very late ST. Multiple predictors of late ST have been identified, and among others, patient's adherence to medical therapy as well as an optimal interventional technique of stent implantation emerge as crucial variables. Scarce data is available about the occurrence of recurrent very late ST. We report three cases of recurrent very late thrombosis of first generation DESs in middle-aged patients with different degrees of coronary artery disease, presenting with acute myocardial infarction.     

药物洗脱支架置人术后断裂导致支架内再狭窄的临床分析

目的 探讨药物洗脱支架(DES)置入术后支架断裂与再狭窄的关系及支架断裂的特点.方法 回顾性分析冠状动脉支架置人术后行冠状动脉造影复查的536例患者,实验分为DES组(N=397)和裸金属支架(BMS)组(n=139).分析支架置入术前、术后及复查时的冠状动脉造影图像,找出支架内再狭窄和支架断裂的病例,分析支架断裂和再狭窄的关系以及支架断裂的病变特征及形态特征.结果 DES组和BMS组再狭窄分别为31例和30例(P＜0.01),其中5例发生支架断裂,断裂的支架均为DES,BMS组未见支架断裂,两组差异有统计学意义(P＜0.05).发生支架断裂的5例靶病变均为扭曲病变,支架断裂均发生在血管扭曲成角处.结论 支架断裂是DES置入术后发生再狭窄的原因之一,扭曲病变置入长的DES后可能容易发生支架断裂.     

Short-term clinical outcome of drug-eluting coronary stent

Objective To evaluate short-term outcome of coronary drug-eluting stent (DES) in patients with coronary artery disease (CAD) by comparing with standard bare stents.