药物洗脱支架血栓形成

支架内血栓形成是支架置入术后少见,但后果严重的并发症,广受关注。支架内血栓形成病因多种多样,包括患者、病变、操作及支架本身等。现对药物涂层支架内血栓形成的相关临床证据和病理生理机制,特别是药物涂层支架本身在其中的作用进行综述。     

同种和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄有效性的系统评价

目的评价同种药物洗脱支架和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄的有效性。方法计算机检索Pub Med、OVID、Embase、Cochrane图书馆、万方数据库、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集同种和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄的临床资料,共纳入10项研究,1680名患者,使用Rev Man5.2软件进行系统评价。检索时间为各大数据库建库至2015年10月。结果在治疗冠状动脉药物洗脱支架内再狭窄时,采用不同药物洗脱支架可降低靶病变血运重建率(OR=0.73,95%CI为0.55~0.96,P=0.02)和主要不良心血管事件发生率(OR=0.72,95%CI为0.54~0.96,P=0.03)。两组间的病死率(OR=1.03,95%CI为0.49~2.16,P=0.95)和心肌梗死发生率(OR=0.59,95%CI为0.24~1.41,P=0.23)无统计学差异。结论对于药物洗脱支架内再狭窄患者,再次植入不同药物洗脱支架比植入同种支架更获益。     

冠状动脉支架内血栓与药物洗脱支架的安全性

最近,药物洗脱支架的安全性问题引起了人们的广泛关注。目前资料表明药物洗脱支架与金属裸支架相比并不引起更多的早、晚期支架内血栓发生,但极晚期支架内血栓形成的风险增加。药物洗脱支架明显降低支架内再狭窄的发生和靶病变的再次血运重建率,其有效性仍优于金属裸支架,尤其对于糖尿病等再狭窄高危患者。根据患者的临床具体情况合理选择支架非常重要。现综述冠状动脉支架内血栓与药物洗脱支架安全性的研究进展。     

药物洗脱支架与冠状动脉内皮功能障碍

冠状动脉支架自问世已有30余年的历程,从金属裸支架(bare metal stent,BMS)到药物洗脱支架(drug eluting stent,DES),其在临床冠心病治疗中已经发挥了巨大作用。BMS的置入能够明显改善经皮冠状动脉腔内血管成形术后     

药物洗脱支架时代支架血栓的研究进展

冠心病的介入治疗已广泛应用于临床.药物洗脱支架作为新技术,被多项临床研究证实其安全性和降低再狭窄率的有效性.药物洗脱支架兴起后短短的几年内,在冠心病的介入治疗中发挥了巨大作用.随着其在临床应用的普及和应用范围的推广,研究发现支架血栓尤其是晚期及极晚期支架有增加的趋势.但是就支架血栓问题,各研究报道不一,临床意义尚不明确,现根据最新研究文献作一综述.     

药物洗脱支架面临新的挑战

冠心病介入治疗(PCI)术后支架内再狭窄长期以来因绕着心脏介入医师,成为冠心病介入治疗后医师关注的焦点。虽然药物洗脱支架大大降低了支架内再狭窄发生率,减少PCI术后靶血管重建、主要心脏事件的发生,但最近的研究结果提示,与置入金属裸支架相比,置入药物洗脱支架增加晚期心肌梗死及死亡的发生。主要原因为晚期支架内血栓形成。在当今药物洗脱支架时代,是否所有的冠心病病人、是否所有冠状动脉病变类型都需要置入药物洗脱支架以及究竟什么病变、病人才能从药物洗脱支架中获益,将再次成为关注的焦点。     

药物洗脱支架与支架内再狭窄

随着药物洗脱支架(Drug Eluting Stent, DES)的出现,再狭窄的问题得到进一步的有效控制,目前的临床证据表明DES总的再狭窄率已经在10%以下.但DES的支架内再狭窄ISR仍是临床介入治疗面临的重要问题.     

合理看待药物洗脱支架晚期血栓问题

冠状动脉支架现广泛应用于冠心病的介入治疗中。支架内血栓是金属裸支架和药物洗脱支架的一个并发症,可导致心肌梗死或死亡。最近,药物洗脱支架引起晚期支架内血栓的问题引起人们的广泛关注。支架血栓的危险因素包括操作因素(如支架贴壁不良、置入支架的数目、支架长度及夹层)、患者及病变因素、过早停用抗血小板药物以及支架释放的药物使内皮延迟愈合等。现对支架晚期血栓的概念、发生的危险因素、防治措施等进行探讨。     

冠状动脉药物洗脱支架内再狭窄的最新研究进展

药物洗脱支架（DES）的诞生和不断优化已经大大提高了经皮冠状动脉介入治疗（PCI）的安全性和有效性,但随着病例复杂性的增加和DES的超适应证应用,术后再狭窄率正逐年上升。因此,当前DES时代下,支架内再狭窄（ISR）仍是临床上亟待解决的一大难题。本文将主要就DES置入后ISR发生发展的病理机制、组织病理学及治疗策略的最新研究成果及进展进行综述。     

药物洗脱球囊与第二代药物洗脱支架治疗药物支架内再狭窄的观察性研究

目的:对中国汉族人群中药物洗脱球囊(DEB)和第二代药物洗脱支架(DES)内再狭窄(ISR)的疗效进行非劣效性比较。方法:连续入选2014年9月至2015年8月,因DES-ISR而接受DEB或第二代DES治疗的患者,根据所接受的治疗策略将患者分别纳入DEB组和第二代DES组。记录两组患者住院期间主要不良心血管事件(MACE)发生率,并于术后12个月通过电话或门诊进行临床随访。结果:共纳入DES-ISR患者183例,包括DEB组74例,DES组109例;根据Mehran分型,非点状病变患者147例。住院期间两组患者均未发生MACE;(12.4±2.9)个月临床随访发现,DEB组共发生MACE 8例,包括心源性死亡1例、非致死性心肌梗死(MI)2例和靶血管血运重建(TVR)6例;第二代DES组MACE 3例,均为TVR。DEB组的MACE发生率高于第二代DES组(11.0%vs.2.8%,P=0.03),并且DEB组的无事件生存率劣于第二代DES组(89.0%vs.97.2%,P非劣效=0.94),而在非点状病变患者中,DEB组患者的无事件生存率仍劣于第二代DES组患者(87.9%vs.96.6%,P非劣效=0.92)。结论:药物洗脱球囊在中国汉族人群中治疗药物洗脱支架内再狭窄的疗效劣于第二代药物洗脱支架,且在非点状病变患者中仍劣于第二代药物洗脱支架。     

Stent as a Novel Technology for Coronary Artery Disease and Their Clinical Manifestation

Coronary artery disease (CAD) is a cardiovascular disease of the blood vessels that makes vessels, narrow and hardened and difficult to supply blood to the heart. The epidemiology of CAD disease is a common clinical syndrome of a global health priority and the burden is increasing at an alarming rate worldwide. The prevalence of CAD not only increases mortality, morbidity and worsens the patient quality of life but also puts a huge burden on the overall healthcare system. The novel risk factors include: cholesterol level, cigarette smoking, diabetics, obesity, and hypertension, respectively are the causative agents of CAD. Furthermore, the etiology of CAD is also a very complex process and several interrelated etiological factors are involved in the pathogenesis of CAD. The signs and symptoms of CAD appear like angina, heart failure, and dyspnea, myocardial infarction, and arrhythmia, respectively. The management and diagnosis of CAD include different types of medications that are used nowadays for the treatment of this disease. The highlights of the present review focused on stent technology and its useful applications. Finally, we also addressed the benefits of the stent, and its potential complications, effectiveness, indication, and contraindication that play a significant role in the recovery of CAD disease.     

Results of Stent Supported Percutaneous Transluminal Coronary Angioplasty in Octogenarians With Coronary Artery Disease

Between January 1995 and July 1998, percutaneous transluminal coronary angioplasty was performed on 27 lesions in 24 octogenarians. Half of the patients were African American. Women comprised 67% of the study group. Patients with unstable angina and myocardial infarction constituted 54% of the cohort. Two-thirds of the patients (83%) had single vessel disease with predominant class A and B lesion complexity of the angioplasty site. Acute success rate was 92%. Stents were successfully placed in 11 subjects (46%). None had acute myocardial infarction, emergency coronary artery bypass surgery, or stroke as a complication of the procedure. One patient presenting with acute myocardial infarction complicated by cardiogenic shock, died. Significant bleeding complications requiring blood transfusions occurred in 17% of patients. Of the patients, 23 (96%) were discharged in a clinically stable condition. Follow up during a two year period was completed in 21 patients (88%). One patient died of cancer. Four subjects (19%) underwent repeat percutaneous transluminal coronary angioplasty. One other patient had recurrent chest pain requiring multiple hospitalizations. The remaining 16 patients (76%) remained free of recurrence of angina. We concluded that percutaneous transluminal coronary angioplasty with stent placement can be performed in octogenarians with a high rate of clinical and angiographic success with an acceptable range of morbidity and mortality, and favorable long term (two year) outcome.     

Obliteration of a Coronary Artery Aneurysm With a PTFE-Covered Stent: Endoluminal Graft for Coronary Disease Revisited

This is the first reported use of the JOSTENT stent graft for aneurysm disease in native coronaries. Consideration can be given to using this polytetrafluoroethylene (PTFE)-covered stent in situations such as dissections and restenosis in saphenous vein grafts or in long native coronary arteries without side branches, though further investigation is warranted. Cathet. Cardiovasc. Intervent. 46:113–116, 1999. © 1999 Wiley-Liss, Inc.     

无保护左主干病变的药物洗脱支架与冠脉搭桥治疗

无保护左主干病变一直是冠脉搭桥治疗的传统领地。随着经皮冠状动脉介入治疗的迅速发展,尤其是药物洗脱支架广泛应用以来,学者们正在用大量的试验证明应用药物洗脱支架治疗无保护左主干病变的安全性、可行性,比较与冠脉搭桥治疗孰优孰劣。随着技术的发展和器械的更新,药物洗脱支架介入治疗的适应证势必进一步拓宽,但是就目前而言,无保护左主干的介入治疗由于其自身不足,不能完全替代冠脉搭桥治疗。