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ʻO Marta Francesca Brancati, 1 Francesco Burzotta, 2 Carlo Trani, 2 Ornella Leonzi, 1 Claudio Cuccia, 1 Filippo Crea2 1 Keʻena o Cardiology, Poliambulanza Foundation Hospital, Brescia, 2 Department of Cardiology, Catholic University of the Sacred Heart of Rome, Italia Abstract: Drug-Eluting bars Stents (DES) liʻiliʻi liʻiliʻi. ma hope o ke komo ʻana o ke coronary percutaneous. Akā naʻe, ʻoiai ʻo ka hoʻokomo ʻia ʻana o ka lua o ka hanauna DES i hoʻohālikelike ʻia i kēia ʻano i hoʻohālikelike ʻia me DES o ka hanauna mua, e mau ana nā hopohopo koʻikoʻi e pili ana i nā hopena hope loa o ka hoʻokomo ʻana i ka stent, e like me ka stent thrombosis (ST) a me ka stent resection. ʻO Stenosis (ISR). ʻO ST kahi hanana pōʻino i hōʻemi nui ʻia ma o ka stenting i hoʻopaʻa ʻia, nā hoʻolālā stent hou, a me ka lāʻau antiplatelet ʻelua. Ke hoʻokolokolo ʻia nei ke ʻano kikoʻī e wehewehe ana i kona hanana ʻana, a ʻoiaʻiʻo, he nui nā kumu. Ua hōʻike ʻia nā haʻawina hauʻoli a me ka mōʻaukala o DES i nā hōʻike o ka ulu mau ʻana o ka neointimal i ka wā lōʻihi o ka hahai ʻana, kahi ʻano i ʻike ʻia ʻo ka "hope catch-up" phenomena. Hoʻohana pinepine ʻia ia e hoʻopau i ka angiography coronary diagnostic a hoʻokele i nā kaʻina hana. neo-atherosclerosis i loko o BMS a me DES. No laila, ua lilo ka neo-atherosclerosis i mea hoʻopiʻi mua i ka pathogenesis o ka hiki ʻole o ka stent hope. Hua'ōlelo: coronary stent, stent thrombosis, restenosis, neoatherosclerosis
ʻO ka hoʻopiʻi ʻana i ke kalapona ʻo Percutaneous coronary intervention (PCI) me ka stent implantation ʻo ia ke kaʻina hana i hoʻohana nui ʻia no ka mālama ʻana i ka maʻi aʻaʻa coronary symptomatic, a ke hoʻomau nei ke ʻano o ka ʻenehana. implantation. , mau pilikia nui.2-5
Inā he hanana pōʻino paha ka ST, ua hoʻopiʻi hou ʻia ka ʻike ʻana he maʻi maikaʻi loa ka ISR e nā hōʻike o ka maʻi coronary acute (ACS) i nā maʻi ISR.4
I kēia lā, ʻike ʻia ʻo intracoronary optical coherence tomography (OCT)6-9 i ka ʻenehana kiʻi kiʻi o kēia manawa, e hāʻawi ana i ka hoʻonā ʻoi aku ka maikaʻi ma mua o ka ultrasound intravascular (IVUS).
Ma 1964, ua wehewehe ʻo Charles Theodore Dotter lāua ʻo Melvin P Judkins i ka angioplasty mua. He lapaʻau hoʻololi ia akā ua loaʻa nā hemahema o ka pani ʻana o ka moku a me ka restenosis.13 ʻO kēia ka mea i alakaʻi i ka ʻike ʻana i nā stents coronary: Ua hoʻokau ʻo Puel lāua ʻo Sigwart i ka stent coronary mua i ka makahiki 1986, e hāʻawi ana i kahi stent e pale ai i ka pani ʻana o ka moku a me ka hoʻihoʻi ʻana o ka systolic. nā ho'āʻo, ka Belgian-Dutch Stent Trial 15 a me ka Stent Restenosis Study 16, ua kākoʻo i ka palekana o ka stenting me ka dual antiplatelet therapy (DAPT) a me / a iʻole nāʻenehana hoʻolālā kūpono.17,18 Ma hope o kēia mau ho'āʻo, ua piʻi nui ka helu o nā PCI i hanaʻia.
Eia naʻe, ua ʻike koke ʻia ka pilikia o iatrogenic in-stent neointimal hyperplasia ma hope o ka hoʻokomo ʻana o BMS, ka hopena i ka ISR ma 20%-30% o nā lesions i mālama ʻia. bypass grafting. I ka makahiki 2005, 80%–90% o nā PCI a pau i hele pū me DES.
Loaʻa i nā mea āpau kona mau hemahema, a mai ka makahiki 2005, ua piʻi aʻe ka hopohopo e pili ana i ka palekana o ka "hanauna mua" DES, a ua hoʻomohala ʻia a hoʻokomo ʻia nā stents hou e like me 20,21.
ʻO ka BMS kahi pahu uea lahilahi mesh. Ma hope o ka ʻike mua ʻana me ka mauna "Wall", mauna ʻo Gianturco-Roubin a me Palmaz-Schatz mauna, nui nā BMS like ʻole i kēia manawa.
ʻEkolu mau manaʻo like ʻole e hiki ke hiki: coil, tubular mesh and slotted tube.Coil designs feature metal wires or strips for a circular coil shape; ʻO nā hoʻolālā tubular mesh e hōʻike ana i nā uwea i ʻōwili pū ʻia i loko o ka ʻupena a lilo i paipu; ʻO nā hoʻolālā pahu slotted he mau paipu metala i ʻoki ʻia i hana ʻia. Ua ʻokoʻa kēia mau mea hana (stainless steel, nichrome, cobalt chrome), hoʻolālā hoʻolālā (nā ʻano strut like ʻole a me nā laula, nā anawaena a me nā lōʻihi, ka ikaika radial, radiopacity) a me nā ʻōnaehana hoʻopuka (hoʻonui pono a i ʻole balloon-expandable).
ʻO ka mea maʻamau, ʻo ka BMS hou he ʻāpana cobalt-chromium, kahi e hopena ai i nā struts thinner me ka hoʻokele maikaʻi ʻana, e mālama ana i ka ikaika mechanical.
Loaʻa iā lākou kahi paepae stent metala (maʻamau he kila kila) a uhi ʻia me kahi polymer e hoʻoheheʻe i nā lāʻau anti-proliferative a / a i ʻole nā ​​​​anti-inflammatory therapeutics.
ʻO Sirolimus (kahi i ʻike ʻia ʻo rapamycin) i hoʻolālā mua ʻia ma ke ʻano he antifungal agent. ʻO kāna hana o ka hana mai ka pale ʻana i ka holomua o ka cell cycle ma ka pale ʻana i ka hoʻololi ʻana mai ka pae G1 a i ka pae S a me ka pale ʻana i ka hoʻokumu ʻana o neointima. ISR. iwakāluakūmāhā
Ua ʻae mua ʻia ʻo Paclitaxel no ka maʻi maʻi ovarian, akā ʻo kona mau waiwai cytostatic ikaika - hoʻopaʻa ka lāʻau i nā microtubules i ka wā o ka mitosis, alakaʻi i ka hopu ʻana o ka cell cycle a pale i ka hoʻokumu ʻana o neointimal - e hoʻohui i ka Taxus Express PES. Ua hōʻike nā hoʻāʻo ʻo TAXUS V a me VI i ka hopena lōʻihi o ka PES i ka maʻi kiʻekiʻe. i hōʻike ʻia i kahi paepae kila kila no ka maʻalahi o ka lawe ʻana.
ʻO nā hōʻike paʻa mai ʻelua mau loiloi ʻōnaehana a me nā meta-analyses e hōʻike ana he ʻoi aku ka maikaʻi o ka SES ma mua o ka PES ma muli o nā haʻahaʻa haʻahaʻa o ISR a me ka revascularization moku pahuhopu (TVR), a me ke ʻano o ka hoʻonui ʻana i ka myocardial infarction (AMI) i ka cohort PES. 27,28
ʻO nā mea hana lua i hoʻemi i ka mānoanoa strut, hoʻomaikaʻi i ka maʻalahi/deliverability, hoʻonui i ka polymer biocompatibility/drug elution profiles, a me nā kinetics re-endothelialization maikaʻi loa.
ʻO Taxus Elements kahi holomua hou me kahi polymer kūʻokoʻa i hoʻolālā ʻia e hoʻonui i ka hoʻokuʻu mua ʻana a me kahi ʻōnaehana platinum-chromium strut hou e hāʻawi ana i nā struts thinner a me ka radiopacity hoʻonui.
Hoʻokumu ʻia ka zotarolimus-eluting stent (ZES) Endeavor ma luna o kahi kahua kobalt-chromium stent ʻoi aku ka ikaika me ka hiki ke kiʻekiʻe a me ka liʻiliʻi o ka stent strut size. ʻO Zotarolimus kahi analog sirolimus me nā hopena immunosuppressive like akā hoʻonui ʻia ka lipophilicity e hoʻomaikaʻi i ka localization o ka moku. i ka wā o ka hōʻeha mua, a ma hope o ka hoʻoponopono ʻana i ke ʻano. ST ma ka hui ZES.31 Akā naʻe, ʻaʻole i hōʻike ka hoʻāʻo PROTECT i ka ʻokoʻa o ka uku ST ma waena o Endeavor a me Cypher stents.32
ʻO Endeavor Resolute kahi mana i hoʻomaikaʻi ʻia o ka Endeavor stent me kahi polymer ʻekolu-layer hou. ʻO ka Resolute Integrity hou (i kapa ʻia ʻo ke kolu o ka hanauna DES) ua hoʻokumu ʻia ma kahi kahua hou me ka hiki ke hāʻawi kiʻekiʻe (ʻo ka Integrity BMS platform), a me kahi moʻolelo, ʻoi aku ka biocompatible ʻekolu-layer polymer , hiki ke hoʻopau i ka lāʻau lapaʻau. mau lā.ʻO kahi ho'āʻo e hoʻohālikelike ana i ka Resolute me Xience V (everolimus-eluting stent [EES]) i hōʻike i ka noinferiority o ka pūnaewele Resolute ma keʻano o ka make a me ka hemahema lesion.33,34
ʻO Everolimus, kahi derivative o sirolimus, ʻo ia hoʻi kahi mea hoʻokaʻawale cell cycle i hoʻohana ʻia i ka hoʻomohala ʻana o Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium platform) EES. Ua hōʻike ka hoʻāʻo SPIRIT 35-37 i ka hoʻomaikaʻi ʻana i ka hana a ua hoʻemi ʻia ka MACE me Xience V i hoʻohālikelike ʻia me PES, ʻoiai ʻo ka EXCELLENT hoʻokolohua i hōʻike ʻia i ka pau ʻana o ka EES a me nā hanana SES i nā mahina hope loa. ma 12 mahina.38 I ka hopena, ua hōʻike ka Xience stent i nā mea maikaʻi ma mua o BMS i ka hoʻonohonoho ʻana o ST-segment elevation myocardial infarction (MI).39
ʻO nā EPC he ʻāpana o nā pūnaewele e hoʻopili ana i ka homeostasis vascular a me ka hoʻoponopono endothelial. ʻO ka hoʻonui ʻana i nā EPC ma ke kahua o ka ʻeha vascular e hoʻoikaika i ka re-endothelialization mua, hiki ke hōʻemi i ka hopena o ka hoʻāʻo mua ʻana o ST.EPC biology ma ke kahua o ka hoʻolālā stent ʻo ia ka CD34 antibody-coated caping Genous markie hematopoietic biology. e hoʻonui i ka re-endothelialization.ʻOiai ua paipai nā haʻawina mua, hōʻike nā hōʻike hou i nā helu kiʻekiʻe o TVR.40
E noʻonoʻo ana i nā hopena hiki ke hoʻopōʻino i ka ho'ōla hoʻopaneʻe ʻana o ka polymer, e pili ana i ka pilikia o ST, hāʻawi nā polymers bioabsorbable i nā pono o DES, e pale ana i nā hopohopo lōʻihi e pili ana i ka hoʻomau ʻana o ka polymer. palena ʻia nā hopena lōʻihi.41
Loaʻa i nā mea bioabsorbable ka pōmaikaʻi o ka hāʻawi mua ʻana i ke kākoʻo mechanical ke noʻonoʻo ʻia ka elastic recoil a hōʻemi i nā pilikia lōʻihi e pili ana i nā struts metala e kū nei. Ua hōʻike ka hoʻokolohua i ka palekana a me ka maikaʻi o nā stents PLLA everolimus-eluting.43 ʻO ka hoʻoponopono hou ʻana o ka stent Absorb i ka lua o ka lua ma mua o ka mea ma mua me ka hahai ʻana i 2 mau makahiki maikaʻi. pono e hoʻomaʻamaʻa maikaʻi ʻia ka ʻenehana, a me ka ʻike palekana no nā ʻeha coronary.
ʻO ka thrombosis ma ka BMS a me ka DES he mau hopena maikaʻi ʻole. Ma kahi papa inoa o nā maʻi e loaʻa ana i ka DES implantation, 47 24% o nā hihia ST i make, 60% mai ka MI non-fatal, a me 7% mai ka angina paʻa ʻole.
Loaʻa i ka Advanced ST nā hopena maʻi ʻino. Ma ka haʻawina BASKET-LATE, 6 a 18 mau mahina ma hope o ka hoʻokomo ʻana i ka stent, ʻoi aku ka kiʻekiʻe o ka nui o ka make cardiac a me ka MI non-fatal i ka hui DES ma mua o ka hui BMS (4.9% a me 1.3%, kēlā me kēia). ma 4 mau makahiki o ka hahai ana, SES (0.6% vs 0%, p = 0.025) a me PES (0.7%) ) ua hoʻonui i ka nui o ka ST hope loa i hoʻohālikelikeʻia me BMS e 0.2%, p = 0.028).49 I ka hoʻohālikelikeʻana, i loko o ka meta-analysis me 5,108 maʻi, 21 a 60 ka hoʻohālikelikeʻana o ka BMS me ka 60% i ka make (BMS). ʻoiai ua pili ʻo PES me kahi piʻi nui ʻole o 15% (Follow-up 9 mahina a 3 mau makahiki).
Nui nā papa inoa, nā ho'āʻo randomized, a me nā meta-analyses i noiʻi i ka pili o ST ma hope o ka BMS a me DES implantation a ua hōʻike i nā hopena kū'ē. 0.6% / makahiki i hoʻohālikelike ʻia me BMS.49 ʻO kahi meta-analysis o nā hoʻāʻo e hoʻohālikelike ana i ka SES a i ʻole PES me BMS i hōʻike i ka piʻi nui o ka make a me ka MI me ka DES o ka hanauna mua i hoʻohālikelike ʻia me BMS, 21 a me kekahi meta-analysis o nā maʻi 4,545 i randomized i SES a i ʻole ʻAʻohe ʻokoʻa i ka hanana o ST ma waena o ka PES a me ka BMS mau makahiki. ʻO ST a me MI i nā maʻi e loaʻa ana ka DES mua ma hope o ka hoʻopau ʻana o DAPT.51
Ma muli o nā hōʻike kū'ē'ē, ua hoʻoholo pū kekahi mau loiloi i hui pū ʻia a me nā meta-analyses ʻaʻole i ʻokoʻa nui ka DES a me BMS o ka hanauna mua i ka pilikia o ka make a i ʻole MI, akā ua piʻi aʻe ka SES a me PES i ka ST kiʻekiʻe loa i hoʻohālikelike ʻia me BMS. No ka nānā ʻana i nā hōʻike i loaʻa, ua koho ka US Food and Drug Administration (FDA) i kahi panela loea53 nāna i hoʻopuka i kahi ʻōlelo e hōʻoia ana he pono ka DES o ka hanauna mua no nā hōʻailona ma ka lepili a he liʻiliʻi ka pilikia o ST kiʻekiʻe loa. ʻO kahi hoʻonui nui. ʻO ka hopena, ʻōlelo ka FDA a me ka hui e hoʻolōʻihi i ka manawa DAPT i 1 makahiki, ʻoiai he liʻiliʻi ka ʻikepili e kākoʻo i kēia koi.
E like me ka mea i ʻōlelo ʻia ma mua, ua hoʻomohala ʻia ka DES lua me nā hiʻohiʻona hoʻolālā kiʻekiʻe. Ua loaʻa nā CoCr-EESs i nā haʻawina hauʻoli loa. 16,775 nā maʻi i loaʻa i ka CoCr-EES i ka haʻahaʻa haʻahaʻa loa, ka hope, 1- a me 2-makahiki maʻamau ST i hoʻohālikelike ʻia me nā DES.
Ua hoʻohālikelikeʻiaʻo Re-ZES me CoCr-EES ma RESOLUTE-AC a me TWENTE ho'āʻo.33,57 ʻAʻohe mea nui i ka hopena o ka make, myocardial infarction, a i ʻole ST definite ma waena o nā stents ʻelua.
Ma kahi pūnaewele meta-analysis o nā maʻi 50,844 me 49 RCTs, ua pili ka 58CoCr-EES me kahi haʻahaʻa haʻahaʻa o ST definite ma mua o BMS, kahi hopena i ʻike ʻole ʻia ma DES ʻē aʻe; ʻaʻole wale ka emi ʻana ma Significant ma mua a ma 30 mau lā (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) a me 1 makahiki (OR 0.27, 95% CI 0.08-0.74) a me 2 makahiki (OR 0.35 CI , 0.97% me ka 0.35 CI , 0.95%). Ua pili ka SES, a me ZES, CoCr-EES me kahi haʻahaʻa o ST ma 1 makahiki.
ʻO ka ST mua e pili ana i nā mea like ʻole. Ke ʻike ʻia nei ka morphology plaque a me ke kaumaha thrombus i ka hopena ma hope o PCI; 59 ʻO ke komo hohonu ʻana ma muli o ka necrotic core (NC) prolapse, nā waimaka medial i ka lōʻihi o ka stent, ka ʻoki ʻana i ke lua me nā koena palena, a i ʻole ka hōʻemi ʻana i ka palena nui ʻO ka stenting maikaʻi loa, ka hoʻopiʻi ʻole ʻana, a me ka hoʻonui ʻole ʻana. Ua like ka BMS me ka DES Rates (<1%).61 No laila, ʻike mua ʻia ka ST mua e pili ana i nā maʻi lapaʻau i lalo a me nā kumu hana.
I kēia lā, ʻoi aku ka nui o ka nānā ʻana i ka ST hope loa / hope loa. ʻO BMS a me DES, nā mea hoʻololi o ke kaʻina hana, e like me ka liʻiliʻi o ka moku, bifurcations, polyvascular disease, calcification, total occlusion, long stents, eʻikeʻia e pili ana me ka pilikia o ST.62,63 ʻAʻole lawa ka pane i ka antiplatelet therapy he kumu pilikia nui no ka holomua DES thrombosis 51 . ʻO kēia pane paha ma muli o ke kanaka maʻi nonabidities, ka hopena o ka lāʻau lapaʻau, ka hopena o ka lāʻau. ʻO ke kiʻekiʻe o ka loaʻa (ʻoi aku ka pale ʻana o ka clopidogrel), a me ka hoʻoponopono ʻana i nā ala ʻē aʻe o ka platelet activation ala. ʻO nā mea. DES e hōʻike ana i ka paia o ka moku i nā lāʻau antiproliferative a me kahi papa hana lāʻau-eluting me nā hopena likeʻole i ka ho'ōla a me ka hana o ka endothelial, me ka hopena o ka thrombosis hope. e alakaʻi ana iā ST.Virmani et al66 i hōʻike i nā ʻike post-mortem post-ST e hōʻike ana i ka hoʻonui ʻana i ka aneurysm ma ka māhele stent me nā hopena hypersensitivity kūloko i haku ʻia me nā T lymphocytes a me nā eosinophils; Hiki i kēia mau ʻike ke hōʻike i ka mana o nā polymers nonerodible.67 ʻO ka malapposition stent ma muli paha o ka hoʻonui ʻana o ka stent suboptimal a i ʻole he mau mahina ma hope o PCI. ʻOiai ʻo ka malapposition kaʻina hana he kumu pilikia no ka ST acute a me ka subacute ST, hiki ke hilinaʻi ke koʻikoʻi o ka loaʻa ʻana o ka stent malapposition i ka hoʻoponopono hou ʻana i ke ʻano o ka lāʻau a i ʻole ka lāʻau lapaʻau.
Hiki i nā hopena pale o DES ka lua o ka hanauna ke komo i ka endothelialization wikiwiki a paʻa, a me nā ʻokoʻa o ka stent alloy a me ka hoʻolālā, ka mānoanoa strut, nā waiwai polymer, a me ke ʻano lāʻau antiproliferative, dosis, a me nā kinetics.
E pili ana me CoCr-EES, hiki ke hoʻonui i ka maʻi ST. Ua hōʻike nā haʻawina hoʻokolohua ʻo ka thrombosis a me ka platelet deposition o nā stents fluoropolymer-coated stents. Loaʻa iā DES nā waiwai like e pono ke aʻo hou ʻia.
Hoʻomaikaʻi nā stents coronary i ka holomua o ka hana ʻana o ka coronary interventions i hoʻohālikelike ʻia me ka percutaneous transluminal coronary angioplasty (PTCA), nona nā pilikia mechanical (vascular occlusion, dissection, etc.) a me nā helu restenosis kiʻekiʻe (a hiki i 40%-50% o nā hihia). Ma ka hopena o nā makahiki 1990, kokoke 70% o nā PCI i hana ʻia me ka hoʻokomo ʻana o BMS.70
Eia nō naʻe, me ka holomua o ka ʻenehana, nā ʻenehana, a me nā lāʻau lapaʻau, ʻo ka pilikia o ka restenosis ma hope o ka hoʻokomo ʻana o BMS ma kahi o 20%, me ka> 40% i nā subgroups kikoʻī.
Hoʻemi hou ka DES i ka hopena o ISR,73 ʻoiai ʻo kēia hoʻemi e pili ana i ka angiography a me ka hoʻonohonoho hoʻonohonoho. nā haʻawina mōʻaukala. 75
ʻO kaʻeha vascular i ka PCI e hana i kahi hana paʻakikī o ka mumū a me ka hoʻoponoponoʻana i kahi manawa pōkole (he pule a hiki i nā mahina), e alakaʻi ana i ka endothelialization a me ka uhi neointimal. E like me ka nānāʻana i ka histopathological,ʻo ka hyperplasia neointimal (BMS a me DES) ma hope o ka hoʻokomoʻiaʻana o ka stent ka mea nui i hakuʻia me nā pūnaewele maʻemaʻe maʻemaʻe ma kahi proteoglycan-rich matrix.
No laila, neointimal hyperplasia hōʻike i ke kaʻina hana hoʻoponopono e pili ana i ka coagulation a me nā mea inflammatory a me nā pūnaewele e hoʻoulu ai i ka hoʻonuiʻana o ka muscle a me ka hoʻokumuʻana o ka matrix extracellular. (CD11b/CD18) a me platelet glycoprotein Ibα 53 a i ʻole fibrinogen i paʻa i ka platelet glycoprotein IIb/IIIa.76,77
Wahi a ka ʻikepili e puka mai ana, pili nā pūpū progenitor i loaʻa i ka iwi iwi i nā pane vascular a me nā kaʻina hana hoʻoponopono. he heluna kanaka paʻa o nā EPC; Ua hōʻike hou nā haʻawina hou i ka CD34 surface antigen e hoʻomaopopo maoli i nā pūnaewele iwi iwi i hoʻokaʻawale ʻole ʻia me ka hiki ke hoʻokaʻawale i nā EPC a me SMPC. ʻO nā kūlana ischemic e hoʻohuli i ka ʻokoʻa i ka phenotype EPC e hāpai i ka re-endothelialization, ʻoiai nā kūlana inflammatory e hoʻohuli i ka ʻokoʻa i ka SMPC phenotype e hāpai i ka neointimal proliferation.79
Hoʻonui ka maʻi diabetes i ka pilikia o ISR e 30% -50% ma hope o ka hoʻokomo ʻana o BMS, 80 a ʻoi aku ka nui o ka restenosis i nā maʻi maʻi maʻi maʻi i hoʻohālikelike ʻia me nā maʻi nondiabetic i hoʻomau pū ʻia i ka wā DES. e piʻi kūʻokoʻa ka Risk o ISR.70
ʻO ke anawaena moku a me ka lōʻihi o ka liona i hoʻopili kūʻokoʻa i ka loaʻa ʻana o ka ISR, me ka liʻiliʻi liʻiliʻi / ʻoi aku ka lōʻihi o nā ʻeha e hoʻonui nui i ka restenosis i hoʻohālikelike ʻia me ka nui aʻe / pōkole pōkole.71
Ua hōʻike ʻia nā paepae stent o ka hanauna mua i nā stent struts mānoanoa a me nā helu ISR kiʻekiʻe aʻe i ka hoʻohālikelike ʻia me nā paepae stent lua o ka hanauna me nā struts thinner.
Eia kekahi, ua pili ka hopena o ka restenosis i ka lōʻihi o ka stent, me ka lōʻihi o ka stent> 35 mm kokoke i ʻelua manawa i ka lōʻihi o kēlā mau <20 mm.
ʻO ka mea maʻamau, ua manaʻo ʻia ka hyperplasia intimal ma hope o ka hoʻokomo ʻia ʻana o BMS, me kahi kiʻekiʻe ma waena o 6 mahina a me 1 makahiki, a ukali ʻia e kahi manawa quiescent hope loa. .83 Eia naʻe, ua hōʻike nā haʻawina me ka lōʻihi lōʻihi o ka hahai ʻana i kahi pane triphasic ma hope o ka waiho ʻana o BMS, me ka restenosis mua, regression waena, a me ka restenosis lumen hope.84
I ka wā DES, ua hōʻike mua ʻia ka ulu ʻana o ka neointimal hope ma hope o ka hoʻokomo ʻana o SES a i ʻole PES i nā ʻano holoholona.85 Ua hōʻike ʻia kekahi mau haʻawina IVUS i kahi attenuation mua o ka ulu ʻana o ka pilina a ukali ʻia e ka hopu hope ʻana i ka manawa ma hope o ka hoʻokomo ʻana o SES a i ʻole PES, ma muli paha o kahi kaʻina hana inflammatory.86
ʻOiai ka "paʻa" maʻamau i pili iā ISR, ma kahi o kahi hapakolu o nā maʻi BMS ISR e hoʻomohala i ka ACS.4
Ke hoʻonui nei nā hōʻike i ka hoʻoulu ʻana o ka maʻi maʻi a me / a i ʻole endothelial insufficiency i ka neoatherosclerosis kiʻekiʻe i loko o BMS a me DES (ʻoi aku ka nui o ka hanauna mua DES), ʻo ia paha kahi hana koʻikoʻi no ka ISR kiʻekiʻe a i ʻole ST.Inoue et al. Ua hōʻike ʻo 87 i nā ʻike histological mai nā laʻana autopsy ma hope o ka hoʻokomo ʻia ʻana o nā stents coronary Palmaz-Schatz, e hōʻike ana e hiki ke hoʻolalelale i ka ʻeha peri-stent i nā loli atherosclerotic indolent hou i loko o ka stent. nā laʻana mai ACS hihia hōʻike typical vulnerable plaques in native coronary arteries Histological morphology of the block with foamy macrophages and cholesterol crystals.In Eia kekahi, i ka hoʻohālikelike ʻana i ka BMS a me DES, ua ʻike ʻia kahi ʻokoʻa nui i ka manawa e hoʻomohala ai i ka atherosclerosis hou. Ua loaʻa nā lesions i 2 mau makahiki ma hope a ua mau ka loaʻa ʻana o ka loaʻa ʻole a hiki i nā makahiki 4. Eia kekahi, ʻo ka DES stenting no nā ʻeha paʻa ʻole e like me ka thin-cap fibroatherosclerosis (TCFA) a i ʻole ka ʻāʻī ʻana he manawa pōkole no ka hoʻomohala ʻana ma mua o ka BMS.
Ke aʻo ʻia nei ka hopena o ka lua o ka hanauna DES a i ʻole DES i ka hoʻomohala ʻana; ʻOiai ke hōʻike nei kekahi mau ʻike o ka lua o ka hanauna DESs88 i ka liʻiliʻi o ka mumū, ua like ka maʻi o ka neoatherosclerosis me ka hanauna mua, akā pono nā noiʻi hou aʻe.