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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 Cardiology, Halemai Poliambulanza Foundation, Brescia, 2 Keʻena Cardiology, Kulanui Katolika o ka Sacred Heart o Roma, Italia Hōʻuluʻulu Manaʻo: Hoʻemi nā Stents Lāʻau Lapaʻau (DES) i nā palena o ka hoʻohana ʻana i nā stents metala ʻōlohelohe (BMS) ma hope o ke komo ʻana o ka coronary percutaneous. Eia nō naʻe, ʻoiai ua hōʻemi ka hoʻolauna ʻana o ka hanauna ʻelua o DES i kēia hanana i hoʻohālikelike ʻia me ka hanauna mua o DES, ke mau nei nā hopohopo nui e pili ana i nā pilikia hope o ka hoʻokomo ʻana o ka stent e like me ka stent thrombosis (ST) a me ka stent resection, stenosis (SSI). He hanana pōʻino paha ʻo ST i hoʻemi nui ʻia e ka hoʻokomo ʻana o ka stent i hoʻomaikaʻi ʻia, nā hoʻolālā stent hou, a me ka lāʻau antiplatelet pālua. Ke noiʻi ʻia nei ke ʻano kikoʻī e wehewehe ana i kona hanana, a he nui nā kumu e kuleana ai. Ua manaʻo mua ʻia ʻo ISR ma BMS he kūlana paʻa me kahi piko mua o ka intimal hyperplasia (ma 6 mau mahina) a ukali ʻia e kahi manawa regression o ʻoi aku ma mua o 1 makahiki. I ka hoʻohālikelike ʻana, ua hōʻike nā haʻawina lapaʻau a me nā histological o DES i nā hōʻike o ka ulu mau ʻana o neointimal ma luna o kahi manawa hahai lōʻihi, kahi hanana i ʻike ʻia ʻo ka hanana "hope catch-up". ʻO ka manaʻo he ʻano lapaʻau maikaʻi ʻole ʻo ISR ua hōʻole ʻia nei e nā hōʻike e hiki i nā maʻi me ISR ke hoʻomohala i nā syndromes coronary acute. ʻO ke kiʻi intracoronary kahi ʻenehana invasive e ʻike ai i nā plaques atherosclerotic stent a me nā hōʻailona o ka ho'ōla ʻana o nā kīʻaha koko ma hope o ka stenting, a hoʻohana pinepine ʻia e hoʻopau i ka angiography coronary diagnostic a hana i nā kaʻina hana interventional. ʻO ka intracoronary optical coherence tomography i kēia manawa i manaʻo ʻia ʻo ia ke ʻano kiʻi holomua loa. Hāʻawi ia, hoʻohālikelike ʻia me ka ultrasound intravascular, i ka hoʻonā maikaʻi aʻe (ma ka liʻiliʻi he >10 mau manawa), e ʻae ana i ke ʻano kikoʻī o ke ʻano superficial o ka paia o ka moku. Hāʻawi ia, hoʻohālikelike ʻia me ka ultrasound intravascular, i ka hoʻonā maikaʻi aʻe (ma ka liʻiliʻi he >10 mau manawa), e ʻae ana i ke ʻano kikoʻī o ke ʻano superficial o ka paia o ka moku. оно обеспечивает, по сравнению с внутрисосудистым УЗИ, лучшее разрешение (по крайней мере, >10 раз), что польдвдо охарактеризовать поверхностную структуру стенки сосуда. Hāʻawi ia, i hoʻohālikelike ʻia me ka ultrasound intravascular, i kahi hoʻonā ʻoi aku ka maikaʻi (ma ka liʻiliʻi he >10 mau manawa), e ʻae ana i kahi wehewehe kikoʻī o ke ʻano o ka ʻili o ka paia o ka moku.与血管内超声相比，它提供了更好的分辨率（至少> 11与血管内超声相比，它提供了更好的分辨率（至少> 10），允许详细表征血管管安。Ke hoʻohālikelike ʻia me ka ultrasound intravascular, hāʻawi ia i kahi hoʻonā maikaʻi aʻe (ma ka liʻiliʻi he 10 mau manawa), e hiki ai ke wehewehe kikoʻī i ke ʻano o ka ʻili o ka paia o ka moku.Hōʻike nā haʻawina kiʻi in vivo e kūlike me nā ʻike histological e hiki i ka mumū mau a me/a i ʻole ka hana ʻole o ka endothelial ke hoʻoulu i ka neoatherosclerosis holomua ma HMS a me DES. No laila, ua lilo ka neoatherosclerosis i mea kānalua nui i ka pathogenesis o ka hāʻule ʻana o ka stent hope. Nā huaʻōlelo koʻikoʻi: stent coronary, stent thrombosis, restenosis, neoatherosclerosis.
ʻO ke komo ʻana o ka coronary percutaneous stent (PCI) ke kaʻina hana i hoʻohana nui ʻia no ka mālama ʻana i ka maʻi artery coronary symptomatic, a ke hoʻomau nei ke ʻano hana i ka ulu ʻana. 1 ʻOiai ʻo nā stents eluting lāʻau lapaʻau (DES) e hōʻemi i nā palena o nā stents uncoated (UES), hiki ke loaʻa nā pilikia hope e like me ka stent thrombosis (ST) a me ka stent restenosis (ISR) me ka hoʻokomo ʻana o ka stent, a ke mau nei nā hopohopo koʻikoʻi. 2-5
Inā he hanana pōʻino paha ʻo ST, ua hoʻopiʻi ʻia ka ʻae ʻana he maʻi maikaʻi ʻole ʻo ISR e nā hōʻike no ka maʻi coronary acute (ACS) i nā maʻi me ISR.
I kēia lā, ua manaʻo ʻia ʻo intracoronary optical coherence tomography (OCT)6-9 he ʻano hana kiʻi hou loa e hāʻawi ana i ka hoʻonā maikaʻi aʻe ma mua o ka ultrasound intravascular (IVUS). Hōʻike nā haʻawina kiʻi in vivo10-12 e kūlike me nā ʻike histological i kahi ʻano pane vascular "hou" ma hope o ka hoʻokomo ʻana o ka stent me ka "neoatherosclerosis" de novo i loko o BMS a me DES.
I ka makahiki 1964, ua wehewehe ʻo Charles Theodore Dotter lāua ʻo Melvin P. Judkins i ka angioplasty mua. I ka makahiki 1978, ua hana ʻo Andreas Grunzig i ka angioplasty balloon mua (ka angioplasty balloon maʻamau kahiko); he lāʻau lapaʻau kipi ia, akā he mau hemahema nō hoʻi ia o ka pani ʻana o nā vascular a me ka restenosis. 13 Ua alakaʻi kēia i ka ʻike ʻana o nā stents coronary: Ua hoʻokomo ʻo Puel lāua ʻo Sigwart i ka stent coronary mua i ka makahiki 1986, e hāʻawi ana i kahi stent e pale aku i ka pani ʻana o nā kīʻaha koko a me ka retraction systolic hope. 14 ʻOiai ua pale kēia mau stents mua i ka pani koke ʻana o ka kīʻaha koko, ua hoʻopilikia nui lākou i ka endothelial a me ka mumū. ʻO ka mea hou loa, ʻelua mau haʻawina koʻikoʻi, ʻo ka Belgian-Dutch Stent Study 15 a me ka Stent Restenosis Study 16, ua kākoʻo i ka palekana o ka dual antiplatelet therapy (DAPT) stenting a/a i ʻole nā ​​​​​​ʻano hoʻolaha kūpono. 17,18 Ma hope o kēia mau hoʻokolohua, ua piʻi nui ka helu o nā PCI i hana ʻia.
Eia nō naʻe, ua ʻike koke ʻia ka pilikia o ka iatrogenic in-stent neointima hyperplasia ma hope o ke kau ʻana o BMS, e hopena ana i ka ISR ma 20-30% o nā lesions i mālama ʻia. Ua hoʻolauna ʻia ʻo DES19 i ka makahiki 2001 e hōʻemi i ka pono no ka restenosis a me ka hana hou ʻana. Ua hoʻonui ʻo DES i ka hilinaʻi o nā cardiologists ma ka ʻae ʻana i ka mālama ʻana i ka nui o nā lesions paʻakikī i manaʻo mua ʻia he hiki ke mālama ʻia me ka coronary artery bypass grafting. I ka makahiki 2005, ua hele pū ʻia ʻo 80-90% o nā PCI āpau me DES.
Loaʻa nā hemahema o nā mea āpau, a mai ka makahiki 2005 ua hoʻonui ʻia nā hopohopo e pili ana i ka palekana o ka DES "hanauna mua", ua hoʻomohala ʻia a hoʻolauna ʻia nā stents hanauna hou e like me 20,21. 22 Mai ia manawa, ua ulu wikiwiki nā hana e hoʻomaikaʻi i ka hana o nā stents, a ua hoʻomau ʻia ka ʻike ʻia ʻana o nā ʻenehana hou hoihoi a lawe koke ʻia i ka mākeke.
He paipu ʻupena uea maikaʻi ka BMS. Ma hope o ka ʻike mua ʻana me ka Wall mount, Gianturco-Roubin mount a me Palmaz-Schatz mount, loaʻa nā ʻano BMS like ʻole he nui i kēia manawa.
ʻEkolu mau hoʻolālā like ʻole i loaʻa: serpentine, tubular mesh a me ka slotted tube. ʻO nā hoʻolālā coil he mau uea metala a i ʻole nā ​​​​ʻāpana e hana ana i kahi ʻano coil poepoe; i nā hoʻolālā tubular mesh, ʻo ka uea i ʻōwili pū ʻia i loko o kahi mesh e hana i kahi paipu; ʻo nā hoʻolālā slotted he mau paipu metala i ʻoki ʻia e ka laser. ʻOkoʻa kēia mau mea hana i ka haku mele (kila kila, nichrome, cobalt chrome), hoʻolālā (nā ʻano spacer like ʻole a me nā laulā, nā diameters a me nā lōʻihi, ka ikaika radial, radiopacity), a me nā ʻōnaehana hāʻawi (hoʻonui ponoʻī a i ʻole balloon-expandable).
Ma ke ʻano he kānāwai, ʻo ka BMS hou he cobalt-chromium alloy, e hopena ana i nā struts lahilahi, hoʻomaikaʻi i ka hana hoʻokele a mālama i ka ikaika mechanical.
Hana ʻia lākou me kahi kahua stent metala (ʻo ke kila kila maʻamau) a ua uhi ʻia me kahi polymer e hoʻokuʻu i nā mea lapaʻau anti-proliferative a/a i ʻole anti-inflammatory.
Ua hoʻomohala mua ʻia ʻo Sirolimus (i ʻike ʻia hoʻi ʻo rapamycin) ma ke ʻano he mea antifungal. Pili kona ʻano hana me ka pale ʻana i ka holomua o ke kaʻina hana cell ma ke kāohi 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. I ka makahiki 2001, ua hōʻike ka ʻike "kanaka mua" me SES i nā hopena hoʻohiki, e alakaʻi ana i ka hoʻomohala ʻana o ka stent Cypher. 23 Ua hōʻike nā hoʻokolohua nui i kona pono i ka pale ʻana i ka IR. 24
Ua ʻāpono mua ʻia ʻo Paclitaxel no ka mālama ʻana i ka maʻi ʻaʻai ovarian, akā ʻo kona mau waiwai cytostatic ikaika—hoʻopaʻa ka lāʻau i nā microtubules i ka wā mitosis, hoʻopau i ke kaʻina hana cell, a kāohi i ka hoʻokumu ʻana o neointimal—e hoʻolilo iā ia i hui no Taxus Express PES. Ua hōʻike nā hoʻokolohua TAXUS V a me VI i ka pono lōʻihi o PES i nā maʻi puʻuwai coronary paʻakikī kiʻekiʻe. 25,26 Ua hōʻike ka TAXUS Liberté ma hope i kahi kahua kila kila no ka maʻalahi o ka lawe ʻana.
Hōʻike nā hōʻike ikaika mai nā loiloi ʻōnaehana ʻelua a me nā meta-analyses he pono ko SES ma mua o PES ma muli o nā helu haʻahaʻa o IVR a me ka revascularization kīʻaha pahuhopu (TVA), a me kahi ʻano e piʻi ai ka myocardial infarction acute (AMI) i ka hui PES. 27.28
Ua hoʻemi ʻia ka mānoanoa o ke koʻokoʻo o nā hāmeʻa hanauna ʻelua, hoʻomaikaʻi ʻia ka maʻalahi/hiki ke hāʻawi ʻia, hoʻomaikaʻi ʻia nā ʻano biocompatibility/drug clearance o ka polymer, a me nā kinetics reendothelialization kiʻekiʻe. I ka hana o kēia manawa, ʻo ia nā hoʻolālā DES holomua loa a me nā stents coronary nui i hoʻokomo ʻia ma ka honua holoʻokoʻa.
Lawe ʻo Taxus Elements i kēia i hoʻokahi ʻanuʻu hou aʻe me kahi polymer kū hoʻokahi i hoʻolālā ʻia no ka hoʻokuʻu mua loa a me kahi ʻōnaehana spacer platinum-chromium hou e hāʻawi ana i nā spacers lahilahi a me ka hoʻonui ʻana i ka radiopacity. Ua ʻike ka haʻawina PERSEUS 29 i nā hopena like ma waena o Element a me Taxus Express a hiki i 12 mau mahina. Eia nō naʻe, ʻaʻole lawa nā hoʻokolohua e hoʻohālikelike ana i nā mea yew me nā DES hanauna ʻē aʻe.
Hoʻokumu ʻia ka Endeavor Zotarolimus Coated Stent (ZES) ma luna o kahi kahua stent cobalt-chromium ikaika me ka maʻalahi kiʻekiʻe a me kahi strut stent liʻiliʻi. ʻO Zotarolimus kahi analogue sirolimus me nā hopena immunosuppressive like, akā me ka lipophilicity i hoʻonui ʻia e hoʻomaikaʻi i ka localization i loko o ka paia o ka moku. Hoʻohana ʻo ZES i kahi uhi polymer phosphorylcholine hou i hoʻolālā ʻia e hoʻonui i ka biocompatibility a hōʻemi i ka mumū. Holoi ʻia ka hapa nui o nā lāʻau i ka wā mua o ka hōʻeha, a ukali ʻia e ka hoʻoponopono arterial. Ma hope o ka hoʻāʻo ENDEAVOR mua, ua hoʻohālikelike ka hoʻāʻo ENDEAVOR III ma hope iā ZES me SES, kahi i hōʻike i ka nalowale lumen hope a me HR akā ʻoi aku ka liʻiliʻi o nā hanana cardiovascular koʻikoʻi (MACEs) ma mua o SES. 30 Ua ʻike hou ka haʻawina ENDEAVOR IV e hoʻohālikelike ana iā ZES me PES i kahi hanana kiʻekiʻe o SIS akā he hanana haʻahaʻa o MI, ma muli paha o ka ST maʻamau loa i ka hui ZES. 31 Eia naʻe, ʻaʻole i hōʻike ka haʻawina PROTECT i kahi ʻokoʻa i ka alapine ST ma waena o nā stents Endeavor a me Cypher. 32
ʻO ka Endeavor Resolute kahi mana i hoʻomaikaʻi ʻia o ka stent Endeavor me kahi polymer ʻekolu papa hou. ʻO ka Resolute Integrity hou (i kekahi manawa i kapa ʻia ʻo ke kolu o ka hanauna DES) ua hoʻokumu ʻia ma luna o kahi kahua hou me nā hiki ke hoʻouna kiʻekiʻe aʻe (ka paepae Integrity BMS) a me kahi polymer ʻekolu papa hou aʻe, ʻoi aku ka biocompatible e hiki ke kāohi i ka pane mumū mua a elute i ka nui o ka lāʻau i nā lā 60 e hiki mai ana. Ua hōʻike ʻia kahi hoʻokolohua e hoʻohālikelike ana iā Resolute me Xience V (everolimus eluting stent [EES]) ua like ka maikaʻi o ka ʻōnaehana Resolute ma ke ʻano o ka make a me ka hāʻule ʻana o ka lesion target. 33.34
ʻO Everolimus, kahi derivative sirolimus, he mea hoʻopaʻa i ke kaʻina hana cell i hoʻohana ʻia i ka hoʻomohala ʻana o EES Xience (Multi-link Vision BMS platform) / Promus (Platinum Chromium platform). Ua hōʻike ka hoʻokolohua SPIRIT 35-37 i nā hopena i hoʻomaikaʻi ʻia a ua hoʻemi ʻia ka MACE me Xience V i hoʻohālikelike ʻia me PES, ʻoiai ua hōʻike ka hoʻokolohua EXCELLENT ua like ka maikaʻi o EES me SES i ka hoʻopau ʻana i ka pohō hope ma 9 mau mahina a me nā hanana lapaʻau ma 12 mau mahina. 38 ʻO ka mea hope loa, ua hōʻike ʻia ka stent Xience e ʻoi aku ka maikaʻi ma mua o BMS i ke ʻano o ka ST elevation myocardial infarction (MI). 39
ʻO nā EPC kahi ʻāpana o nā pūnaewele e kaapuni ana i komo i ka homeostasis vascular a me ka hoʻoponopono endothelial. ʻO ka hoʻonui ʻia ʻana o ka EPC ma kahi o ka ʻeha vascular e paipai i ka re-endothelialization mua, e hōʻemi ana paha i ka pilikia o ST. ʻO ka hoʻomaka mua ʻana o EPC Biology i ka hoʻolālā stent ʻo ia ka stent Genous, i uhi ʻia me nā antibodies anti-CD34, hiki ke hoʻopaʻa i nā EPC e kaapuni ana ma o kāna mau māka hematopoietic e hoʻoikaika i ka re-endothelialization. ʻOiai ua hoʻoikaika nā haʻawina mua, kuhikuhi nā hōʻike hou i nā helu TVR kiʻekiʻe. 40
Ma muli o nā hopena maikaʻi ʻole o ka ho'ōla lohi i hoʻokomo ʻia e ka polymer e pili ana me ka pilikia ST, hāʻawi nā polymers bioresorbable i nā pono o DES ma ka pale ʻana i nā hopohopo lōʻihi e pili ana i ka hoʻomau ʻana o ka polymer. A hiki i kēia lā, ua ʻae ʻia nā ʻōnaehana bioresorbable like ʻole (e laʻa, Nobori lāua ʻo Biomatrix, biolimus eluting stent, Synergy, EES, Ultimaster, SES), akā ua kaupalena ʻia nā palapala e kākoʻo ana i kā lākou hopena lōʻihi. 41
Loaʻa i nā mea bioabsorbable ka pono theoretical o ka hāʻawi ʻana i ke kākoʻo mechanical i ka wā mua ke noʻonoʻo ʻia ka recoil elastic a me ka hōʻemi ʻana i nā pilikia lōʻihi e pili ana me nā struts metala e kū nei. Ua alakaʻi nā ʻenehana hou i ka hoʻomohala ʻana o nā polymers lactic acid (poly-l-lactic acid [PLLA]), akā he nui nā ʻōnaehana stent e hoʻomohala ʻia nei, ʻoiai ʻo ka loaʻa ʻana o ke kaulike kūpono ma waena o ka elution lāʻau a me nā kinetics degradation he mea paʻakikī ia. Ua hōʻike ka haʻawina ABSORB i ka palekana a me ka pono o nā stents PLLA i uhi ʻia e everolimus. 43 ʻOi aku ka maikaʻi o ka hoʻoponopono hou ʻana o ka stent Absorb hanauna ʻelua ma mua o ka mea ma mua me kahi hahai maikaʻi 2 makahiki. 44 ʻO ke aʻo ʻana o ABSORB II o kēia manawa, ʻo ka hoʻokolohua randomized mua e hoʻohālikelike ana i ka stent Absorb me ka stent Xience Prime, pono e hāʻawi i ka ʻikepili hou aku, a ʻo nā hopena mua i loaʻa he mea hoʻohiki. 45 Eia nō naʻe, pono e wehewehe ʻia nā kūlana kūpono, ke ʻano hana implantation maikaʻi loa, a me ka ʻike palekana i ka maʻi artery coronary.
Loaʻa i ka Thrombosis ma BMS a me DES nā hopena lapaʻau maikaʻi ʻole. Ma kahi papa inoa o nā maʻi i hoʻokomo ʻia me DES,47 24% o nā hihia ST i hopena i ka make, 60% i ka MI make ʻole, a me 7% i ka angina paʻa ʻole. ʻO ka PCI no ka ST wikiwiki ka maʻamau suboptimal, me ka hoʻi hou ʻana i 12% o nā hihia. 48
Loaʻa i ka ST hoʻonui ʻia nā hopena lapaʻau maikaʻi ʻole. Ma ke aʻo ʻana o BASKET-LATE, 6-18 mau mahina ma hope o ke kau ʻana o ka stent, ʻoi aku ka kiʻekiʻe o ka make ʻana o ka puʻuwai a me ka MI make ʻole i ka hui DES ma mua o ka hui SMP (4.9% a me 1.3%, kēlā me kēia). 20 Ua hōʻike ʻia kahi meta-analysis o ʻeiwa mau haʻawina kahi i hoʻokaʻawale ʻia ai nā maʻi 5261 i SES, PES, a i ʻole BMS ma hope o 4 mau makahiki o ka hahai ʻana, ua hoʻonui ʻo SES (0.6% versus 0%, p = 0.025) a me PES (0.7%)) i ka nui o ka ST hope loa i hoʻohālikelike ʻia me BMS ma 0.2%, p = 0.028). 49 I ka hoʻohālikelike ʻana, ma kahi meta-analysis e komo pū ana me 5108 mau maʻi, 21 ua hōʻike ʻia kahi piʻi pili o 60% i ka make a i ʻole MI me SES i hoʻohālikelike ʻia me BMS (p = 0.03), ʻoiai ua pili ʻo PES me ka piʻi nui ʻole o 15% (e nānā - a hiki i 9 mau mahina a 3 mau makahiki).
Ua nānā nā papa inoa he nui, nā hoʻokolohua randomized, a me nā meta-analyses i ka pilikia pili o ST ma hope o ka hoʻokomo ʻana o BMS a me DES a ua hōʻike i nā hopena kūʻē. Ma kahi papa inoa o 6906 mau maʻi i mālama ʻia me BMS a i ʻole DES, ʻaʻohe ʻokoʻa i nā hopena lapaʻau a i ʻole nā ​​​​helu ST ma 1 makahiki o ka hahai ʻana. 48 Ma kekahi papa inoa ʻē aʻe o 8146 mau maʻi, ua ʻike ʻia ka pilikia o ka nui o ST mau loa he 0.6% i kēlā me kēia makahiki i hoʻohālikelike ʻia me BMS. 49 Ua hōʻike ʻia kahi meta-analysis o nā haʻawina e hoʻohālikelike ana iā SES a i ʻole PES me SMPs i ka piʻi ʻana o ka pilikia o ka make a me MI me DES hanauna mua i hoʻohālikelike ʻia me SMPs, 21 a me kekahi meta-analysis o 4545 mau maʻi i randomized i SES a i ʻole ST ma waena o PES a me BMS ma 4 mau makahiki o ka hahai ʻana. 50 Ua hōʻike nā haʻawina honua maoli ʻē aʻe i ka piʻi ʻana o ka pilikia o ST a me MI holomua i nā maʻi i mālama ʻia me DES hanauna mua ma hope o ka hoʻopau ʻana o DAPT. 51
Ma muli o ka ʻikepili kū'ē, ua hoʻoholo pū kekahi mau loiloi i hōʻuluʻulu ʻia a me nā meta-analyses ʻaʻole i ʻokoʻa nui ka DES a me ka hanauna mua SGM i ka pilikia o ka make a i ʻole MI, akā ua ʻoi aku ka nui o ka pilikia o SES a me PES i ka ST maʻamau loa i hoʻohālikelike ʻia me SGM. 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 ʻike ana he pono ka hanauna mua DES e like me ka mea i lepili ʻia a he liʻiliʻi ka pilikia o nā pae holomua loa ST, akā ʻaʻole nui. , Piʻi nui. ʻO ka hopena, paipai ka FDA a me ka hui e hoʻolōʻihi i ka manawa DAPT i 1 makahiki, ʻoiai he liʻiliʻi nā hōʻike e kākoʻo i kēia koi.
E like me ka mea i ʻōlelo ʻia ma mua, ua hoʻomohala ʻia ka lua o ka hanauna DES me nā hiʻohiʻona hoʻolālā i hoʻomaikaʻi ʻia. Ua hana ʻo CoCr-EES i ka noiʻi lapaʻau ākea loa. Ma kahi meta-analysis na Baber et al.54 o 17,101 mau maʻi, ua hōʻemi nui ʻo CoCr-EES i ka ST a me MI maopopo/hiki ke hoʻohālikelike ʻia me PES, SES, a me ZES i 21 mau mahina. ʻO ka mea hope loa, ua hōʻike ʻo Palmerini et al ma kahi meta-analysis o 16,775 mau maʻi he haʻahaʻa loa ka CoCr-EES i ka mua, ka hope, 1- a me 2-makahiki ST i wehewehe ʻia i hoʻohālikelike ʻia me nā DES ʻē aʻe i hui pū ʻia. 55 Ua hōʻike nā haʻawina ola maoli i ka emi ʻana o ka pilikia o ST me CoCr-EES i hoʻohālikelike ʻia me ka hanauna mua DES. 56
Ua hoʻohālikelike ʻia ʻo Re-ZES me CoCr-EES i nā haʻawina RESOLUTE-AC a me TWENTE. 33,57 ʻAʻohe ʻokoʻa koʻikoʻi i ka make, ka myocardial infarction, a i ʻole ka wehewehe ʻana o ka ʻāpana ST ma waena o nā stents ʻelua.
Ma kahi meta-analysis pūnaewele o 50,844 mau maʻi, me 49 RCTs, ua pili ʻo 58 CoCr-EES me kahi hanana haʻahaʻa loa o ST i wehewehe ʻia ma mua o BMS, kahi ʻike i ʻike ʻole ʻia me nā DES ʻē aʻe; ʻaʻole wale ka emi ʻana ma ka "mua loa" a ma hope o 30 mau lā (58). odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) a ma 1 makahiki (OR 0.27, 95% CI 0.08-0.74) a me 2 mau makahiki (OR 0.35, 95% CI 0.17–0.69). Ke hoʻohālikelike ʻia me PES, SES, a me ZES, ua pili ʻo CoCr-EES me kahi helu ST haʻahaʻa ma 1 makahiki.
Hoʻopili ʻia ka ST mua me nā kumu like ʻole. ʻO ke ʻano o ka plaque ma lalo a me ke kaumaha thrombus e like me ka hoʻohuli i ka hopena ma hope o ka PCI;59 ʻo ke komo hohonu ʻana o nā struts e ka necrotic core (NC) prolapse, ka haehae medial lōʻihi i loko o ka stent, ka stenting suboptimal me nā dissections lihi koena a i ʻole ka stenosis lihi koʻikoʻi, ka apposition piha ʻole, a me ka hoʻonui piha ʻole o ka stent i hoʻokomo ʻia e hoʻonui i ka pilikia o ST.60 ʻAʻole hoʻohuli nui ka regimen therapeutic o nā lāʻau antiplatelet i ka hanana o ST mua: i loko o kahi hoʻokolohua randomized e hoʻohālikelike ana i nā BMS me DES, ua like nā helu o ST acute a me subacute i ka wā o DAPT (<1%).61 No laila, ʻike ʻia ʻo ST mua e pili nui ana i nā lesions i mālama ʻia ma lalo a me nā kumu kaʻina hana. ʻO ke ʻano o ka plaque ma lalo a me ke kaumaha thrombus e like me ka hoʻohuli i ka hopena ma hope o ka PCI;59 ʻo ke komo hohonu ʻana o nā struts e ka necrotic core (NC) prolapse, ka haehae medial lōʻihi i loko o ka stent, ka stenting suboptimal me nā dissections lihi koena a i ʻole ka stenosis lihi koʻikoʻi, ka apposition piha ʻole, a me ka hoʻonui piha ʻole ʻana o ka stent i hoʻokomo ʻia e hoʻonui i ka pilikia o ST.60 ʻAʻole hoʻohuli nui ka regimen therapeutic o nā lāʻau antiplatelet i ka hanana o ST mua: i loko o kahi hoʻokolohua randomized e hoʻohālikelike ana i nā BMS me DES, ua like nā helu o ST acute a me subacute i ka wā o DAPT (<1%) .61 No laila, ʻike ʻia ʻo ST mua e pili nui ana i nā lesions i mālama ʻia ma lalo a me nā kumu kaʻina hana. Морфология лежащей в основе бляшки и тромбоз, по-видимому, влияют на исход после ЧКВ;59 бонпека трация из-за пролапса некротического ядра (NC), длинного медиального разрыва внутри стента, субоптимального стентиромстимкич расслоениями или значительным краевым стенозом, неполной аппозицией и неполным расширением имплантированного стента может увеличить рискчевик Т.60 антитромбоцитарных препаратов не оказывает существенного влияния на частоту раннего ST: в рандомизированном исслед исслед DES, частота острого и подострого ST во время DAPT была одинаковой (<1%) .61 Таким образом, ранняя ST, по-видимому, в первую очередь связана с лежанщироми в лежансироми поражениями и процедурными факторами. ʻIke ʻia ke ʻano o ka plaque ma lalo a me ka thrombosis e hoʻopilikia i ka hopena ma hope o ka PCI;59 ka komo hohonu ʻana o ke strut ma muli o ka necrotic nucleus (NC) prolapse, ka haehae medial lōʻihi i loko o ka stent, ka stenting suboptimal me nā delaminations marginal koena a i ʻole ka stenosis marginal koʻikoʻi, ka hoʻopili piha ʻole a me ka hoʻonui piha ʻole o kahi stent i hoʻokomo ʻia e hoʻonui i ka pilikia o ST.60 ʻAʻole pili nui ka regimen therapeutic o nā lāʻau antiplatelet i ka hanana o ST mua: i loko o kahi hoʻokolohua randomized e hoʻohālikelike ana iā BMS a me DES, ʻo ka hanana o ST acute a me subacute i ka wā o DAPT ua like (<1%) .61 No laila, ʻike ʻia ʻo ST mua e pili nui ana i nā lesions i mālama ʻia a me nā kumu kaʻina hana.潜在的斑块形态和血栓负荷似乎影响PCI 后的结果；59 坏死核心(NC)脱垂导致的更深的支柱穿透、支架内长的内侧撕裂、具有残余边缘剥离或显着边缘狭窄的次优支架、不完全并置和不完全扩张60 抗血小板药物的治疗方案不会显着影响早期ST 的发生率：在一项比较BMS 与DES 的随与DES 的随是生期间急性和亚急性ST 的发生率相似（<1%） .61 因此，早期ST似乎主要与潜在的治疗病变和手术因素有关。潜在 的 斑块 形态 和 血栓 似乎 影响 影响 pci 后 结果 ； ； ； ； ； 坏 死 坏 死核心 核心 核心 脱垂 导致 的 深 的 支柱 穿透 、 内长 的 内侧 、 具有 残余 残余边缘 狭窄 次 次 次 次 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 的 优 支架 、 不 完全 并置和 帍 扩 不 扩 不抗血 小板 药物 的 治疗 方案 不 显着 影响 影响 早期 的 ： 在 项 比较 比七 des bms期间 急性 亚急性 的 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生 发生发生 发生 发生 发生 发生 发生 发生 发生 发生率相似（<1%） .61ʻIke ʻia ke ʻano o ka plaque ma lalo a me ka thrombosis e hoʻohuli i nā hopena ma hope o ka PCI; 59 ʻO ka komo hohonu ʻana o ka strut ma muli o ka necrotic nucleus (NC) prolapse, nā haki medial i ka lōʻihi o ka stent, ka dissection lua me nā palena koena, a i ʻole ka palena koʻikoʻi e hoʻohaiki ana ʻO ka stenting maikaʻi loa, ka apposition piha ʻole, a me ka hoʻonui piha ʻole60 ʻAʻohe hopena koʻikoʻi o ka regimen Antiplatelet i ka hanana ST mua: ʻo ka hanana o ka ST acute a me ka subacute i ka wā o DAPT i kahi hoʻokolohua randomized e hoʻohālikelike ana iā BMS a me DES. pili nui i nā lesions therapeutic ma lalo a me nā mea ʻoki.
I kēia lā, ʻo ke kālele nui ʻana ma ka ST hope/hope loa. ʻOiai ʻo nā kumu hana a me nā mea loea e like me ke kuleana nui i ka hoʻomohala ʻana o ka ST ʻoi a me ka subacute, ʻoi aku ka paʻakikī o ke ʻano o nā hanana thrombotic lohi. Ua manaʻo ʻia he mau mea pilikia paha kekahi mau ʻano o ka mea maʻi no ka ST holomua a holomua loa: diabetes mellitus, ACS i ka manawa o ke ʻoki mua ʻana, ka hāʻule ʻana o ka renal, ka makahiki kiʻekiʻe, ka emi ʻana o ka ejection fraction, nā hanana cardiac maikaʻi ʻole i loko o 30 mau lā o ke ʻoki mua ʻana. No BMS a me DES, ʻo nā loli hana e like me ka nui o nā kīʻaha koko liʻiliʻi, nā bifurcations, nā maʻi multivascular, calcification, ka occlusion piha, nā stents lōʻihi e like me ka pili ʻana me ka pilikia o ka ST holomua. 62,63 ʻO ka pane maikaʻi ʻole i ka lāʻau antiplatelet kahi mea pilikia nui no ka thrombosis DES holomua 51. Hiki i kēia pane ke kumu o ka hoʻokō ʻole o ka mea maʻi, ka underdose, nā pilina lāʻau, nā comorbidities e pili ana i ka pane lāʻau, ka polymorphism genetic receptor-level (ʻoi aku ka pale ʻana o clopidogrel), a me ka hoʻāla ʻana o nā ala ʻē aʻe no ka hoʻāla ʻana o ka platelet. Ua manaʻo ʻia ʻo Stent neoatherosclerosis he ʻano hana koʻikoʻi no ka hāʻule ʻana o ka stent hope, me ka ST64 hope (ʻāpana "Stent Neoatherosclerosis"). Hoʻokaʻawale ka endothelium paʻa i ka paia o ke kīʻaha koko thrombosed a me nā pou stent mai ke kahe koko a hūnā i nā mea antithrombotic a me nā vasodilatory. Hōʻike ʻo DES i ka paia o ke kīʻaha koko i nā lāʻau anti-proliferative a me kahi kahua hoʻokuʻu lāʻau, me nā hopena like ʻole ma ka ho'ōla a me ka hana endothelial, me ka pilikia o ka thrombosis hope. 65 Ua hōʻike ʻia nā haʻawina pathological e hiki i nā polymers DES hanauna mua ikaika ke kōkua i ka mumū mau, ka waiho ʻana o ka fibrin mau, ka hoʻōla endothelial maikaʻi ʻole, a no laila ua hoʻonui ʻia ka pilikia o ka thrombosis. 3 ʻO ka hypersensitivity hope i ka DES me he mea lā he ʻano hana ʻē aʻe e alakaʻi ana i ka ST. Ua hōʻike ʻo Virmani et al. [66] i nā ʻike postmortem ma hope o ST e hōʻike ana i ka hoʻonui ʻana o ka aneurysm i ka ʻāpana stent me nā hopena hypersensitivity kūloko e pili ana i nā T-lymphocytes a me nā eosinophils; hiki i kēia mau ʻike ke hōʻike i ka mana o nā polymers hiki ʻole ke luku ʻia. 67 Hiki ke kūpono ʻole ka stent ma muli o ka hoʻonui ʻana o ka stent suboptimal a i ʻole e hana ʻia kekahi mau mahina ma hope o ka PCI. ʻOiai ʻo ka malapposition procedural he mea pilikia no ka ST acute a me subacute, ʻo ke koʻikoʻi lapaʻau o ka malapposition stent i loaʻa e hilinaʻi paha i ka hoʻoponopono hou ʻana o ke arterial aggressive a i ʻole ka hoʻōla lohi ʻana i hoʻoulu ʻia e ka lāʻau lapaʻau, akā he mea hoʻopaʻapaʻa kona pili lapaʻau. 68
ʻO nā hopena palekana o ka lua o ka hanauna DES e komo pū me ka endothelialization wikiwiki a ʻoi aku ka maikaʻi, a me nā ʻokoʻa i ka stent alloy a me ke ʻano, ka mānoanoa o ke strut, nā waiwai polymer, a me ke ʻano lāʻau antiproliferative, ka nui, a me nā kinetics.
Ke hoʻohālikelike ʻia me CoCr-EES, ʻo nā scaffolds stent cobalt-chromium lahilahi (81 µm), nā fluoropolymers antithrombotic, ka haʻahaʻa o ka polymer, a me ka hoʻouka lāʻau lapaʻau e kōkua paha i nā helu ST haʻahaʻa. Ua hōʻike nā haʻawina hoʻokolohua he haʻahaʻa loa ka thrombosis a me ka waiho ʻana o ka platelet i nā stents i uhi ʻia me ka fluoropolymer ma mua o nā stents i uhi ʻole ʻia. 69 Inā he mau waiwai like ko nā DES hanauna ʻē aʻe, pono e hoʻomau ʻia ke aʻo ʻana.
Hoʻomaikaʻi nā stent coronary i ka holomua o ke ʻoki ʻana o nā hana coronary i hoʻohālikelike ʻia me ka percutaneous transluminal coronary angioplasty (PTCA) kuʻuna, nona nā pilikia mechanical (vascular occlusion, dissection, etc.) a me ka nui o nā restenoses (a hiki i ka 40-50% o nā hihia). I ka hopena o nā makahiki 1990, ua hana ʻia kokoke i ka 70% o nā PCI me ka hoʻokomo ʻana o BGM. 70
然而，尽管技术、技术和药物治疗取得了进步，但BMS植入后再狭窄的风险约为20%，在特定亚组中发生率> 40%.然而，尽管技术、技术和药物治疗取得了进步，但BMSEia nō naʻe, ʻoiai ka holomua o ka ʻenehana, nā ʻano hana, a me nā lāʻau lapaʻau, ʻo ka pilikia o ka restenosis ma hope o ke kau ʻana o BMS ma kahi o 20%, me nā helu e ʻoi aku ana ma mua o 40% i kekahi mau hui liʻiliʻi. 71 Ma ke ʻano laulā, ua hōʻike nā haʻawina lapaʻau e hiki i ka restenosis ma hope o ke kau ʻana o BMS, e like me ka mea i ʻike ʻia me ka PTCA maʻamau, ke piʻi nei i 3-6 mau mahina a hoʻopau i 1 makahiki. 72
Hoʻemi hou aku ʻo DES i nā helu ISR,73 ʻoiai ʻo kēia hōʻemi e pili ana i ka angiographically a me ke ʻano lapaʻau. Hoʻokuʻu ka uhi polymer DES i nā mea anti-inflammatory a me nā anti-proliferative, kāohi i ka hoʻokumu ʻana o neointima, a hoʻopaneʻe i ka hoʻoponopono vascular i nā mahina a i ʻole nā ​​​​makahiki.74 I nā haʻawina lapaʻau a me nā histological, ua ʻike ʻia ka ulu mau ʻana o neointima ma luna o kahi manawa hahai lōʻihi ma hope o ka hoʻokomo ʻana o DES, kahi hanana i ʻike ʻia ʻo "late catch-up" 75.
ʻO ka hōʻeha ʻana o ke koko i ka wā o ka PCI e hoʻoulu ai i kahi kaʻina hana paʻakikī o ka mumū a me ka hoʻoponopono ʻana i kahi manawa pōkole (nā pule a i nā mahina), e hopena ana i ka endothelialization a me ka uhi ʻana o neointimal. Wahi a nā nānā histopathological, ʻo ka hyperplasia neointimal (HMS a me DES) ma hope o ka hoʻokomo ʻana o ka stent i hana nui ʻia me nā cell muscle smooth proliferative i loko o kahi matrix extracellular waiwai proteoglycan. 70
No laila, ʻo ka hyperplasia neointimal kahi hana hoʻoponopono e pili ana i ka coagulation a me nā mea mumū, a me nā cell e hoʻoulu ai i ka hoʻonui ʻana o nā cell muscle laumania a me ka hoʻokumu ʻana o ka matrix extracellular. Ma hope koke iho o ka PCI, ua waiho ʻia nā platelets a me ka fibrin ma ka paia o ke kīʻaha koko a huki i nā leukocytes ma o kahi moʻo o nā molekala hoʻopili cell. Hoʻopili nā leukocytes ʻōwili i nā platelets i hoʻopili ʻia ma o ka launa pū ʻana ma waena o ka leukocyte integrin Mac-1 (CD11b/CD18) a me ka platelet glycoprotein Ibα 53 a i ʻole fibrinogen e pili ana me ka platelet glycoprotein IIb/IIIa. 76.77
Wahi a ka ʻikepili hou, pili nā pūnaewele progenitor iwi i nā hopena vascular a me nā kaʻina hana hoʻoponopono. ʻO ka hoʻoneʻe ʻana o ka EPC mai ka iwi iwi a i ke koko peripheral e paipai i ka hoʻoulu hou ʻana o ka endothelial a me ka neovascularization postnatal. Me he mea lā e neʻe ana nā pūnaewele progenitor ʻiʻo laumania o ka iwi (SMPC) i kahi o ka ʻeha vascular, e hopena ana i ka hoʻonui ʻana o ka neointimal. 78 Ma mua, ua manaʻo ʻia nā pūnaewele CD34-positive he heluna paʻa o EPC, ua hōʻike nā haʻawina hou aʻe ua ʻike maoli ka antigen surface CD34 i nā pūnaewele kumu iwi ʻokoʻa me ka hiki ke hoʻokaʻawale i nā EPC a me nā PBMC. ʻO ka transdifferentiation o nā pūnaewele CD34-positive i loko o kahi laina EPC a i ʻole SMPC e pili ana i ke kaiapuni kūloko; hoʻoulu nā kūlana ischemic i ka hoʻokaʻawale ʻana i ka phenotype EPC, kahi e paipai ai i ka reendothelialization, ʻoiai nā kūlana mumū e hoʻoulu ai i ka hoʻokaʻawale ʻana i ka phenotype SMPC, kahi e paipai ai i ka hoʻonui ʻana o ka neointimal. 79
Hoʻonui ka maʻi diabetes i ka pilikia o ISR ma 30-50% ma hope o ke kau ʻana o BMS, a ʻo ke kiʻekiʻe o ka restenosis i ka maʻi diabetes i hoʻohālikelike ʻia me nā poʻe maʻi ʻaʻole maʻi diabetes ua mau nō hoʻi i ka wā DES. ʻO nā ʻano hana e pili ana i kēia nānā ʻana he multifactorial paha, me ka systemic (e laʻa, ka loli o ka pane mumū) a me ka anatomical (e laʻa, nā kīʻaha koko liʻiliʻi, nā ʻeha lōʻihi, ka maʻi diffuse, a pēlā aku), kahi e hoʻonui kūʻokoʻa ai i ka pilikia o ISR. 70
Ua hoʻopilikia kūʻokoʻa ke anawaena o ka moku a me ka lōʻihi o ka ʻeha i nā helu ISR, me ke anawaena liʻiliʻi/nā ʻeha lōʻihi e hoʻonui nui ana i nā helu restenosis i hoʻohālikelike ʻia me ke anawaena nui/nā ʻeha pōkole. 71
Ua hōʻike nā kahua stent o ka hanauna mua i nā struts stent mānoanoa a me nā ISR kiʻekiʻe i ka hoʻohālikelike ʻana me nā kahua stent o ka hanauna ʻelua me nā struts lahilahi.
Eia kekahi, pili ka nui o ka restenosis me ka lōʻihi o ka stent, kokoke i ka pāpālua no ka lōʻihi o ka stent >35 mm ke hoʻohālikelike ʻia me nā mea <20 mm. Eia kekahi, pili ka nui o ka restenosis me ka lōʻihi o ka stent, kokoke i ka pāpālua no ka lōʻihi o ka stent >35 mm ke hoʻohālikelike ʻia me nā mea <20 mm. Кроме того, частота рестеноза связана с длиной стента, почти удваиваясь при длине стента >35 мм по сравнению <с дмлиной2 стента Eia kekahi, pili ka nui o ka restenosis i ka lōʻihi o ka stent, kokoke e pāpālua me ka lōʻihi o ka stent >35 mm ke hoʻohālikelike ʻia me ka lōʻihi o ka stent <20 mm.此外，再狭窄的发生率与支架长度有关，支架长度>35 mm 的支架长度几乎是<20 mm 的两倍此外，再狭窄的发生率与支架长度有关，支架长度>35 mm Кроме того, частота рестеноза зависела от длины стента: длина стента >35 мм почти в два раза больше, чем стента <20 мм. Eia kekahi, ua pili ke alapine (frequency) o ka restenosis i ka lōʻihi o ka stent: ʻo ka lōʻihi o ka stent >35 mm ua aneane pālua ia o ka lōʻihi o ka stent <20 mm.Ua hoʻokani pū kekahi ke anawaena lumen liʻiliʻi loa o ka stent i kahi kuleana koʻikoʻi: ua wānana kahi anawaena lumen liʻiliʻi loa i ka piʻi nui ʻana o ka pilikia o ka restenosis. 81.82
ʻO ka mea maʻamau, ua manaʻo ʻia ka hyperplasia intimal ma hope o ke kau ʻana o BMS he paʻa, me kahi kiʻekiʻe mua ma waena o 6 mau mahina a me 1 makahiki i ukali ʻia e kahi wā hiamoe hope. Ua hōʻike mua ʻia kahi kiʻekiʻe mua o ka ulu ʻana o intimal i ukali ʻia e ka regression intimal me ka hoʻonui ʻana o ka lumen i kekahi mau makahiki ma hope o ke kau ʻana o stent; ua manaʻo ʻia ka oʻo ʻana o nā cell muscle laumania a me nā loli i loko o ka matrix extracellular e like me nā ʻano hana hiki no ka regression neointima hope. 83 Eia nō naʻe, ua hōʻike nā haʻawina hahai lōʻihi i kahi pane triphasic ma hope o ke kau ʻana o BMS me ka restenosis mua, ka regression waena, a me ka restenosis luminal hope. 84
I ka wā DES, ua hōʻike mua ʻia ka ulu ʻana o ka neointimal hope ma hope o ke kau ʻana o SES a i ʻole PES i nā hiʻohiʻona holoholona. 85 Ua hōʻike kekahi mau haʻawina IVUS i ka emi mua ʻana o ka ulu ʻana o ka intimal i ukali ʻia e ka hopu ʻana i ka hala ʻana o ka manawa ma hope o ke kau ʻana o SES a i ʻole RPE, ma muli paha o ke kaʻina hana mumū e hoʻomau nei.86
ʻOiai ke "paʻa" i hāʻawi mau ʻia i ka ISR, ma kahi o ka hapakolu o nā maʻi me BMS ISR e hoʻomohala i ka ACS. ʻehā
Aia ka nui o nā hōʻike e hōʻike ana i ka mumū mau a me/a i ʻole ka hemahema endothelial e hoʻoulu ai i ka neoatherosclerosis holomua ma HCM a me DES (ʻo ia hoʻi ka hanauna mua o DES), kahi mea nui paha no ka hoʻomohala ʻana o ka IR holomua a i ʻole ST holomua. Ua hōʻike ʻo Inoue et al [87] i nā ʻike autopsy histological ma hope o ke kau ʻana o nā stents coronary Palmaz-Schatz, e hōʻike ana e hiki i ka mumū a puni ka stent ke hoʻoulu i nā loli atherosclerotic indolent hou i loko o ka stent. Ua hōʻike ʻia nā haʻawina ʻē aʻe10 ʻo ka ʻiʻo restenotic i loko o 5 makahiki CGM he atherosclerosis hoʻomaka hou me ka ʻole o ka mumū peritoneal; hōʻike nā specimens mai nā hihia ACS i nā plaques palupalu maʻamau i nā arteries coronary maoli Histological block morphology me nā macrophages foamy a me nā kristal cholesterol. Eia kekahi, i ka hoʻohālikelike ʻana iā BMS a me DES, ua ʻike ʻia kahi ʻokoʻa koʻikoʻi i ka manawa i ka hoʻomohala ʻana o ka atherosclerosis hou. 11,12 Ua hoʻomaka nā loli atherosclerotic mua loa i ka foamy macrophage infiltration 4 mau mahina ma hope o ke kau ʻana o SES, ʻoiai nā loli like i nā lesions CGM i hana ʻia ma hope o 2 mau makahiki a ua noho mau he ʻike kakaikahi a hiki i 4 mau makahiki. Eia kekahi, ʻo ka DES stenting no nā lesions paʻa ʻole e like me ka thin tegmental fibroatherosclerosis (TCFA) a i ʻole ka intimal rupture he manawa pōkole ia e ulu ai i hoʻohālikelike ʻia me BMS. No laila, ʻike ʻia ka neoatherosclerosis he mea maʻamau a loaʻa mua i ka hanauna mua o DES ma mua o BMS, malia paha ma muli o kahi pathogenesis ʻokoʻa.
ʻAʻole pono e ʻimi ʻia ka hopena o ka lua o ka hanauna DES a i ʻole DES i ka hoʻomohala ʻana; ʻoiai kekahi mau nānā ʻana o ka lua o ka hanauna DES88 e hōʻike ana i ka emi ʻana o ka mumū, ua like ka nui o ka neoatherosclerosis i hoʻohālikelike ʻia me ka hanauna mua, akā pono mau nā haʻawina hou aʻe.