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Marta Francesca Brancati, 1 Francesco Burzotta, 2 Carlo Trani, 2 Ornella Leonzi, 1 Claudio Cuccia, 1 Filippo Crea2 1 Ngalaba Cardiology, Poliambulanza Foundation Hospital, Brescia, 2 Ngalaba Cardiology, Mahadum Katọlik nke Obi Nsọ nke Rome, Italy Nchịkọta: Ọgwụ Stents a kpụchara akpụ (DES) na-ebelata oke ojiji stents metal efu (BMS) mgbe etinyere aka na akwara obi. Agbanyeghị, ọ bụ ezie na mmalite nke DES nke ọgbọ nke abụọ yiri ka ọ belatara ihe a ma e jiri ya tụnyere DES nke ọgbọ mbụ, nchegbu dị ukwuu ka dị gbasara nsogbu ndị nwere ike ịbịa n'oge nke itinye stent dịka stent thrombosis (ST) na mwepụ stent, stenosis (SSI). ST bụ ihe nwere ike ịkpata ọdachi nke ebelatala nke ukwuu site na ntinye stent kachasị mma, atụmatụ stent ọhụrụ, na ọgwụgwọ antiplatelet abụọ. A na-enyocha usoro kpọmkwem nke na-akọwa ihe na-eme ya, n'ezie ọtụtụ ihe kpatara ya. A na-ewere ISR na BMS dị ka ọnọdụ kwụsiri ike nke nwere oke mmalite nke hyperplasia intimal (na ọnwa 6) wee soro oge nlọghachi nke ihe karịrị otu afọ. N'ụzọ dị iche, ma ọmụmụ ahụike na histological nke DES egosila ihe akaebe nke uto neointimal na-aga n'ihu n'oge nlele ogologo oge, ihe a maara dị ka ihe "nsogbu njide oge". Echiche ahụ na ISR bụ ọnọdụ ahụike dị nro ka ihe akaebe na-egosi na ndị ọrịa nwere ISR nwere ike ịmalite ọrịa coronary syndromes dị oke njọ agbaghaala n'oge na-adịbeghị anya. Imaging intracoronary bụ usoro ịwakpo iji chọpụta plaques atherosclerotic stented na ihe ịrịba ama nke ọgwụgwọ arịa ọbara mgbe stenting gasịrị, a na-ejikwa ya eme ihe iji mezue nchọpụta ọrịa coronary angiography ma mee usoro ọgwụgwọ. A na-ewere tomography intracoronary optical coherence ugbu a dị ka ụzọ onyonyo kachasị elu. Ọ na-enye, ma e jiri ya tụnyere ultrasound intravascular, mkpebi ka mma (ma ọ dịkarịa ala ugboro 10), na-enye ohere ịkọwapụta nkọwa zuru ezu nke nhazi elu nke mgbidi arịa ahụ. Ọ na-enye, ma e jiri ya tụnyere ultrasound intravascular, mkpebi ka mma (ma ọ dịkarịa ala ugboro 10), na-enye ohere ịkọwapụta nkọwa zuru ezu nke nhazi elu nke mgbidi arịa ahụ. оно обеспечивает, по сравнению с внутрисосудистым УЗИ, лучшее разрешение (по крайней мере, >10 разени), детально охарактеризовать поверхностную структуру стенки сосуда. Ọ na-enye, ma e jiri ya tụnyere ultrasound intravascular, mkpebi ka mma (ma ọ dịkarịa ala ugboro 10), nke na-enye ohere ịkọwapụta nkọwa zuru ezu nke nhazi elu nke mgbidi arịa ahụ.与血管内超声相比，它提供了更好的分辨率（至少> 10 倍）。与血管内超声相比，它提供了更好的分辨率（至少> 10）。Ma e jiri ya tụnyere ultrasound intravascular, ọ na-enye mkpebi ka mma (ma ọ dịkarịa ala ugboro 10), nke na-enye ohere ịkọwapụta nkọwa zuru ezu nke nhazi elu nke mgbidi arịa ahụ.Nnyocha onyonyo dị na vivo nke kwekọrọ na nchọpụta histological na-egosi na mbufụt na-adịghị ala ala na/ma ọ bụ nsogbu endothelial nwere ike ibute neoatherosclerosis dị elu na HMS na DES. Ya mere, neoatherosclerosis aghọwo ihe a na-enyo enyo na ọ bụ ya kpatara ọdịda stent n'oge. Isi okwu: coronary stent, stent thrombosis, restenosis, neoatherosclerosis.
Ọgwụgwọ akwara obi nke a na-akpọ stented percutaneous coronary intervention (PCI) bụ usoro a na-ejikarị eme ihe maka ọgwụgwọ nke ọrịa akwara obi nke na-egosi ihe mgbaàmà, usoro a na-agakwa n'ihu na-agbanwe agbanwe. 1 Ọ bụ ezie na ọgwụ na-ewepụta stents (DES) na-ebelata oke nke stents a na-ekpuchighị ekpuchi (UES), nsogbu ndị na-abịa n'oge dịka na stent thrombosis (ST) na stent restenosis (ISR) nwere ike ime na stent implantation, nchegbu ndị dị oke njọ ka dị. 2-5
Ọ bụrụ na ST bụ ihe nwere ike ịkpata ọdachi, nkwenye na ISR bụ ọrịa na-adịghị mma abụrụla ihe akaebe maka ọrịa akwara obi (ACS) na ndị ọrịa nwere ISR.
Taa, a na-ewere intracoronary optical coherence tomography (OCT)6-9 dị ka usoro onyonyo ọgbara ọhụrụ nke na-enye mkpebi ka mma karịa intravascular ultrasound (IVUS). Ọmụmụ onyonyo in vivo10-12 nke kwekọrọ na nchọpụta histological na-egosi usoro nzaghachi vaskụla "ọhụrụ" mgbe etinyere stent na de novo "neoatherosclerosis" n'ime BMS na DES.
Na 1964, Charles Theodore Dotter na Melvin P. Judkins kọwara angioplasty mbụ ahụ. Na 1978, Andreas Grunzig mere angioplasty mbụ nke balloon (angioplasty ochie nke balloon); ọ bụ ọgwụgwọ mgbanwe, mana o nwekwara ọghọm nke mmechi akwara na restenosis. 13 Nke a mere ka a chọpụta stents akwara: Puel na Sigwart tinyere stent akwara mbụ na 1986, na-enye stent iji gbochie mmechi akwara ngwa ngwa na ịlaghachi azụ n'oge systolic. 14 Ọ bụ ezie na stents mbụ ndị a gbochiri mmechi nke arịa ahụ ozugbo, ha kpatara nnukwu mmebi endothelial na mbufụt. N'oge na-adịbeghị anya, ọmụmụ ihe abụọ dị mkpa, Ọmụmụ Stent nke Belgium-Dutch nke 15 na Ọmụmụ Stent Restenosis nke 16, akwadola nchekwa nke ọgwụgwọ antiplatelet abụọ (DAPT) stent na/ma ọ bụ ụzọ ntinye kwesịrị ekwesị. 17,18 Mgbe nnwale ndị a gasịrị, ọnụọgụ PCI emere mụbara nke ukwuu.
Agbanyeghị, a chọpụtara nsogbu nke iatrogenic in-stent neointima hyperplasia mgbe etinyechara BMS ngwa ngwa, nke mere ka ISR dị na 20–30% nke ọnya ndị a gwọrọ. E webatara DES19 na 2001 iji belata mkpa maka restenosis na ịwa ahụ ọzọ. DES emeela ka ndị dọkịta obi nwekwuo obi ike site n'ikwe ka a gwọọ ọtụtụ ọnya ndị dị mgbagwoju anya nke a na-ewerebu dị ka ihe a pụrụ ịgwọ site na iji usoro akwara obi. Na 2005, 80–90% nke PCI niile so DES.
Ihe niile nwere nsogbu ya, kemgbe afọ 2005, nchegbu gbasara nchekwa nke "ọgbọ mbụ" DES amụbaala, emepụtala ma webata stents ọgbọ ọhụrụ dị ka 20,21. 22 Kemgbe ahụ, mgbalị iji melite arụmọrụ nke stents amụbaala ngwa ngwa, a ka na-achọpụtakwa teknụzụ ọhụrụ na-atọ ụtọ ma na-ebute ha n'ahịa ngwa ngwa.
BMS bụ ọkpọkọ waya dị mma. Mgbe ha mechara ahụmịhe mbụ ha na Wall mount, Gianturco-Roubin mount na Palmaz-Schatz mount, ọtụtụ BMS dị iche iche dị ugbu a.
E nwere ụdị atọ dị iche iche: serpentine, tube mesh na tube slotted. Nhazi eriri nwere waya ígwè ma ọ bụ mpempe ígwè na-eme ọdịdị okirikiri nke eriri; na nhazi eriri tubular, waya a kpọkọtara ọnụ ka ọ bụrụ waya na-emepụta tube; nhazi oghere nwere tube ígwè nke a na-egbutu na laser. Ngwaọrụ ndị a dị iche na nhazi (ígwè anaghị agba nchara, nichrome, cobalt chrome), nhazi (ụdị na obosara dị iche iche nke oghere, dayameta na ogologo, ike radial, rediopacity), na sistemụ nnyefe (nke na-agbasa onwe ya ma ọ bụ nke a na-agbasa na balloon).
Dịka iwu si dị, BMS ọhụrụ ahụ nwere cobalt-chromium alloy, nke na-eme ka struts dị gịrịgịrị, meziwanye arụmọrụ ịnya ụgbọala ma nọgide na-enwe ike igwe.
Ha nwere ikpo okwu stent ígwè (nke na-abụkarị ígwè anaghị agba nchara) ma e ji ihe polymer kpuchie ha nke na-ewepụta ihe ndị na-egbochi mmụba na/ma ọ bụ ihe ndị na-egbochi mbufụt.
E mepụtara Sirolimus (a makwaara dị ka rapamycin) dị ka ihe na-akpata nje. Usoro ọrụ ya na-ejikọta ya na igbochi ọganihu nke usoro mkpụrụ ndụ site na igbochi mgbanwe site na usoro G1 gaa na usoro S na igbochi nhazi neointima. Na 2001, ahụmịhe "mmadụ mbụ" na SES gosipụtara nsonaazụ dị mma, nke butere mmepe nke stent Cypher. 23 Nnukwu nnwale egosila na ọ dị irè n'igbochi IR. 24
A nabatara Paclitaxel na mbụ maka ọgwụgwọ kansa ovarian, mana ikike ya dị ike nke cytostatic - ọgwụ ahụ na-eme ka microtubules kwụsie ike n'oge mitosis, na-akpata njide okirikiri sel, ma na-egbochi mmepụta neointimal - na-eme ka ọ bụrụ ihe mejupụtara Taxus Express PES. Nnwale TAXUS V na VI gosipụtara irè ogologo oge nke PES na ọrịa obi dị mgbagwoju anya nke nwere nnukwu ihe egwu. 25,26 TAXUS Liberté sochirinụ gosipụtara ikpo okwu ígwè anaghị agba nchara maka mfe nnyefe.
Ihe akaebe siri ike sitere na nyocha usoro abụọ na meta-analyses na-egosi na SES nwere uru karịa PES n'ihi obere ọnụego IVR na revascularization arịa ebumnuche (TVA), yana usoro nke mmụba na nnukwu myocardial infarction (AMI) na otu PES. 27.28
Ngwaọrụ ọgbọ nke abụọ nwere obere ọkpụrụkpụ nke ogwe, mmezi/nnweta ka mma, mmezi nke polymer biocompatibility/ọgwụ clearance, yana usoro reendothelialization ka mma. N'ọrụ ugbu a, ndị a bụ atụmatụ DES kachasị elu na nnukwu stents coronary etinyere n'ụwa niile.
Taxus Elements na-eme nke a ọzọ site na iji polima pụrụ iche e mere maka mwepụta kachasị elu n'oge na sistemụ platinum-chromium spacer ọhụrụ nke na-enye oghere dị gịrịgịrị na mmụba redio. Ọmụmụ PERSEUS 29 kwuru ihe yiri nke ahụ n'etiti Element na Taxus Express ruo ọnwa 12. Agbanyeghị, enweghị nnwale zuru oke iji tụnyere ihe ndị dị ka yew na ọgbọ nke abụọ DES.
E ji ikpo okwu stent cobalt-chromium siri ike nke nwere mgbanwe dị elu na obere stent strut. Zotarolimus bụ sirolimus analogue nwere mmetụta mgbochi ahụ ike yiri nke ahụ, mana ọ na-abawanye lipophilicity iji melite ebe obibi na mgbidi arịa ọbara. ZES na-eji mkpuchi phosphorylcholine polymer ọhụrụ nke e mere iji mee ka biocompatibility dịkwuo elu ma belata mbufụt. A na-asacha ọtụtụ ọgwụ n'oge mbụ nke mmerụ ahụ, wee mechaa ndozi akwara. Mgbe nnwale ENDEAVOR mbụ gasịrị, nnwale ENDEAVOR III sochirinụ tụnyere ZES na SES, nke gosipụtara mfu lumen dị elu na HR mana obere ihe omume obi ọjọọ dị njọ (MACEs) karịa SES. 30 Ọmụmụ ENDEAVOR IV nke tụnyere ZES na PES chọtara ọzọ mmụba nke SIS mana obere mmụba nke MI, ikekwe n'ihi ST a na-ahụkarị na otu ZES. 31 Agbanyeghị, ọmụmụ ihe PROTECT egosighi ọdịiche na ugboro ST n'etiti Endeavor na Cypher stents. 32
Endeavor Resolute bụ ụdị Endeavor stent ka mma nke nwere polymer ọhụrụ nwere akwa atọ. Resolute Integrity ọhụrụ (nke a na-akpọ DES ọgbọ nke atọ mgbe ụfọdụ) dabere na ikpo okwu ọhụrụ nwere ikike nnyefe dị elu (ikpo okwu Integrity BMS) na polymer ọhụrụ, nke dabara adaba karịa nke nwere akwa atọ nke nwere ike igbochi nzaghachi mkpali mbụ ma wepụ ọgwụ ahụ n'ime ụbọchị 60 sochirinụ. Nnwale tụnyere Resolute na Xience V (everolimus eluting stent [EES]) gosiri na sistemụ Resolute dị irè n'ihe gbasara ọnwụ na ọdịda mmerụ ahụ. 33.34
Everolimus, ihe sitere na sirolimus, bụkwa ihe na-egbochi okirikiri sel nke ejiri na mmepe nke EES Xience (Multi-link Vision BMS platform)/Promus (platinum Chromium platform). Nnwale SPIRIT 35-37 gosipụtara nsonaazụ ka mma ma belata MACE na Xience V ma e jiri ya tụnyere PES, ebe nnwale EXCELLENT gosiri na EES dị mma dịka SES n'igbochi mfu oge na ọnwa 9 na ihe omume ahụike na ọnwa 12. 38 N'ikpeazụ, egosiri na Xience stent dị mma karịa BMS n'ọnọdụ ST elevation myocardial infarction (MI). 39
EPCs bụ otu n'ime mkpụrụ ndụ na-agagharị agagharị nke na-etinye aka na homeostasis nke arịa ọbara na ndozi endothelial. Mmụba EPC n'ebe mmerụ ahụ akwara ga-akwalite mweghachi endothelialization n'oge, nke nwere ike ibelata ihe egwu nke ST. Ụzọ mbụ EPC Biology si arụpụta stent bụ Genous stent, nke e ji ọgwụ mgbochi CD34 kpuchie, nke nwere ike ijikọ EPCs na-agagharị site na ihe nrịbama hematopoietic ya iji mee ka re-endothelialization dịkwuo mma. Ọ bụ ezie na ọmụmụ ihe mbụ na-agba ume, ihe akaebe na-adịbeghị anya na-egosi na ọnụego TVR dị elu. 40
Ebe ọ bụ na e nwere ike inwe mmetụta ọjọọ nke ọgwụgwọ oge nke polymer kpatara nke jikọtara ya na ihe egwu ST, polima bioresorbable na-enye uru nke DES site n'izere nchegbu ogologo oge gbasara ntachi obi polima. Ruo taa, a kwadola ọtụtụ sistemụ bioresorbable (dịka ọmụmaatụ, Nobori na Biomatrix, biolimus eluting stent, Synergy, EES, Ultimaster, SES), mana akwụkwọ ndị na-akwado nsonaazụ ogologo oge ha pere mpe. 41
Ihe ndị a na-amịkọrọ ihe ndị na-amịkọrọ ihe nwere uru echiche nke inye nkwado igwe na mbụ mgbe a tụlere nlọghachi azụ na-agbanwe agbanwe ma belata ihe egwu ogologo oge metụtara struts metal dị adị. Teknụzụ ọhụrụ edugala na mmepe nke lactic acid polymers (poly-l-lactic acid [PLLA]), mana ọtụtụ sistemụ stent ka na-etolite, ọ bụ ezie na ịchọta nguzozi zuru oke n'etiti mwepụ ọgwụ na mmebi kinetics ka bụ ihe ịma aka. Ọmụmụ ihe ABSORB gosipụtara nchekwa na irè nke stents PLLA nke everolimus kpuchiri. 43 Ndozigharị nke ọgbọ nke abụọ Absorb stent dị mma karịa nke gara aga yana ezigbo nleba anya afọ 2. 44 Ọmụmụ ihe ABSORB II dị ugbu a, nnwale mbụ enweghị usoro atụnyere na-atụnyere Absorb stent na Xience Prime stent, kwesịrị inye data ndị ọzọ, nsonaazụ mbụ dịnụ na-ekwe nkwa. 45 Agbanyeghị, ọ dị mkpa ka a kọwaa ọnọdụ kachasị mma, usoro ntinye kacha mma, na profaịlụ nchekwa na ọrịa akwara obi.
Thrombosis na BMS na DES nwere nsonaazụ ọjọọ n'ụlọ ọgwụ. N'ime ndekọ nke ndị ọrịa e tinyere DES, 47% nke ndị ọrịa ST butere ọnwụ, 60% na MI na-anaghị egbu egbu, na 7% na angina na-adịghị agbanwe agbanwe. PCI maka ST ngwa ngwa anaghị adị mma, yana nlọghachi na 12% nke ikpe. 48
ST Extended nwere ike ibute nsogbu ahụike. N'ọmụmụ BASKET-LATE, ọnwa 6-18 mgbe etinyechara stent, ọnụọgụ ọnwụ obi na MI na-anaghị egbu egbu dị elu na otu DES karịa na otu SMP (4.9% na 1.3%, n'otu n'otu). 20 Nyocha meta nke ọmụmụ itoolu ebe e tinyere ndị ọrịa 5261 na SES, PES, ma ọ bụ BMS n'usoro gosiri na mgbe afọ 4 nke nleba anya gasịrị, SES (0.6% megide 0%, p = 0.025) na PES (0.7%) mụbara ohere nke ST n'oge na-adịghị anya ma e jiri ya tụnyere BMS site na 0.2%, p = 0.028). 49 N'ụzọ dị iche, na nyocha meta nke gụnyere ndị ọrịa 5108, 21 kọrọ mmụba nke ọnwụ ma ọ bụ MI 60% na SES ma e jiri ya tụnyere BMS (p = 0.03), ebe ejikọtara PES na mmụba na-enweghị isi nke 15% (lee - ruo ọnwa 9 ruo afọ 3).
Ọtụtụ ndebanye aha, nnwale ndị a na-eme n'usoro, na nyocha meta-analyses enyochaala ihe egwu dị na ST mgbe etinyere BMS na DES ma kọọ nsonaazụ na-emegiderịta onwe ha. N'ime ndekọ nke ndị ọrịa 6906 ejiri BMS ma ọ bụ DES gwọọ, enweghị ọdịiche dị na nsonaazụ ahụike ma ọ bụ ọnụego ST na otu afọ nke nleba anya. 48 N'ime ndekọ ọzọ nke ndị ọrịa 8146, a chọpụtara na ihe egwu nke oke ST na-aga n'ihu bụ 0.6% kwa afọ ma e jiri ya tụnyere BMS. 49 Nyocha meta nke ọmụmụ ndị na-atụnyere SES ma ọ bụ PES na SMPs gosiri mmụba nke ihe egwu nke ọnwụ na MI na ọgbọ mbụ DES ma e jiri ya tụnyere SMPs, 21 na nyocha meta-analyses ọzọ nke ndị ọrịa 4545 nke a na-eme n'usoro na SES ma ọ bụ ST n'etiti PES na BMS na afọ 4 nke nleba anya. 50 Ọmụmụ ihe ndị ọzọ n'ụwa egosipụtala mmụba nke ihe egwu nke ST na MI na-aga n'ihu na ndị ọrịa ejiri DES ọgbọ mbụ gwọọ mgbe akwụsịchara DAPT. 51
N'ihi data dị iche iche, ọtụtụ nyocha na meta-analyses jikọtara ọnụ kpebiri na DES na SGM ọgbọ mbụ adịghị iche nke ukwuu n'ihe ize ndụ nke ọnwụ ma ọ bụ MI, mana SES na PES nwere nnukwu ihe ize ndụ nke ST a na-ahụkarị ma e jiri ya tụnyere SGM. Iji nyochaa ihe akaebe dị, US Food and Drug Administration (FDA) họpụtara otu ndị ọkachamara53 nke wepụtara nkwupụta na-aghọta na DES ọgbọ mbụ dị irè dị ka aha ya na ihe ize ndụ nke ọkwa ST dị elu dị obere, mana ọ bụghị nnukwu. , Mmụba dị ukwuu. N'ihi ya, FDA na njikọ ahụ na-akwado ịgbatị oge DAPT ruo otu afọ, ọ bụ ezie na enweghị obere ihe akaebe iji kwado nkwupụta a.
Dịka ekwuru na mbụ, e mepụtala DES nke ọgbọ nke abụọ site na iji atụmatụ imewe ka mma. CoCr-EES emeela nchọpụta ahụike kachasị ukwuu. Na nyocha meta nke Baber et al.54 nke ndị ọrịa 17,101, CoCr-EES belatara nke ukwuu ST na MI doro anya/nwere ike ịbụ ma e jiri ya tụnyere PES, SES, na ZES na ọnwa 21. N'ikpeazụ, Palmerini et al. gosiri na nyocha meta nke ndị ọrịa 16,775 na CoCr-EES nwere ST akọwapụtara nke ukwuu n'oge, n'oge, na afọ 1 na 2 ma e jiri ya tụnyere DES ndị ọzọ agụnyere. Ọmụmụ ihe ndụ 55 egosila mbelata n'ihe ize ndụ nke ST na CoCr-EES ma e jiri ya tụnyere DES nke ọgbọ mbụ. 56
A tụnyere Re-ZES na CoCr-EES n'ọmụmụ ihe RESOLUTE-AC na TWENTE. 33,57 Enweghị nnukwu ọdịiche dị n'ọnwụ, nkụchi obi, ma ọ bụ akụkụ ST akọwapụtara n'etiti stents abụọ ahụ.
N'ime nyocha nke ndị ọrịa 50,844, gụnyere RCT 49, 58 CoCr-EES jikọtara ya na obere mmụba nke ST akọwapụtara karịa BMS, nchọpụta a na-ahụbeghị na DES ndị ọzọ; mbelata ahụ abụghị naanị na "n'oge dị oke mkpa" na mgbe ụbọchị 30 gasịrị (58). Oke odds [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) na na 1 afọ (OR 0.27, 95% CI 0.08-0.74) na afọ 2 (OR 0.35, 95% CI 0.17–0.69). Ma e jiri ya tụnyere PES, SES, na ZES, ejikọtara CoCr-EES na obere ọnụego ST na 1 afọ.
Mmalite ST jikọtara ya na ihe dị iche iche. Ọdịdị plaque na ibu thrombus yiri ka ọ na-emetụta ihe ga-esi na ya pụta mgbe PCI gasịrị;59 miri emi struts ịbanye site na necrotic core (NC) prolapse, ogologo medial diaper n'ime stent, obere stenting na-enweghị mma yana mwepu akụkụ fọdụrụ ma ọ bụ nnukwu stenosis nke akụkụ, ntinye zuru oke, na mgbasawanye zuru oke nke stent etinyere nwere ike ịbawanye ohere nke ST.60 Usoro ọgwụgwọ nke ọgwụ antiplatelet anaghị emetụta nke ukwuu na mmalite ST: na nnwale enweghị usoro na-atụnyere BMS na DES, ọnụego nke nnukwu na subacute ST n'oge DAPT yiri nke ahụ (<1%).61 Ya mere, ST mbụ yiri ka ọ bụ isi ihe metụtara mmerụ ahụ ndị a gwọrọ na ihe ndị metụtara usoro. Ọdịdị plaque na ibu thrombus yiri ka ọ na-emetụta ihe ga-esi na ya pụta mgbe PCI gasịrị;59 miri emi struts ịbanye site na necrotic core (NC) prolapse, ogologo medial diaper n'ime stent, obere stenting na-enweghị mma yana mwepu akụkụ fọdụrụ ma ọ bụ nnukwu stenosis nke akụkụ, ntinye zuru oke, na mgbasawanye zuru oke nke stent etinyere nwere ike ịbawanye ohere nke ST.60 Usoro ọgwụgwọ nke ọgwụ antiplatelet anaghị emetụta nke ukwuu na mmalite ST: na nnwale enweghị usoro na-atụnyere BMS na DES, ọnụego nke nnukwu na subacute ST n'oge DAPT yiri nke ahụ (<1%) .61 Ya mere, ST mbụ yiri ka ọ bụ isi ihe metụtara mmerụ ahụ ndị a gwọrọ na ihe ndị metụtara usoro. Морфология лежащей в основе бляшки и тромбоз, по-видимому, влияют на исход после ЧКВ;59 пенетрация распорок из-за пролапса некротического ядра (NC), . . . неполным расширением имплантированного сента может увеличить препаратов не оказывает существенного влияния на частоту раннего ST: в рандомизированном исследовании, частота острого и подострого ST время DAPT была одинаковой (<1%) .61 Таким образом, ранnyaя ST, по-видивимому первую очередь связана с лежащими в основе пролеченным Ọdịdị plaque na thrombosis dị n'okpuru yiri ka ọ na-emetụta ihe ga-esi na ya pụta mgbe PCI gasịrị;59 strut strike injection n'ihi necrotic nucleus (NC) prolapse, ogologo medial diaper n'ime stent, stenting na-adịghị mma na residual margin delamitions ma ọ bụ nnukwu margin stenosis, ezughị ezu itinye na ezughị ezu nke stent etinyere nwere ike ịbawanye ohere nke ST.60 Usoro ọgwụgwọ nke ọgwụ antiplatelet anaghị emetụta nke ukwuu na ST mbụ: na nnwale enweghị usoro na-atụnyere BMS na DES, ihe omume nke acute na subacute ST n'oge DAPT bụ otu ihe ahụ (<1%) .61 Ya mere, ST mbụ yiri ka ọ bụ isi ihe metụtara mmerụ ahụ ndị a gwọrọ na ihe ndị metụtara usoro.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 .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 一栓 似乎 影响 影响 pci 后 结果核心 核心 核心 脱垂 导來边缘 狭窄 次 不 完全 并置和 不 次 次 不抗血 小板 药物 的 治疗 方案 不 显着 影响期间 急性 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 发生率相伈（<1%） .61Ọdịdị plaque na thrombosis dị n'okpuru yiri ka ọ na-emetụta ihe ga-esi na ya pụta mgbe PCI gasịrị; 59 Mbanye miri emi n'ihi necrotic nucleus (NC) prolapse, mgbawa etiti n'ogologo stent, nkewa nke abụọ na oke fọdụrụ, ma ọ bụ mbelata oke dị ukwuu stent kacha mma, ntinye zuru oke, na mgbasawanye ezughị ezu60 Usoro antiplatelet enweghị mmetụta dị ukwuu na mmalite ST: ihe omume nke nnukwu ST na subacute n'oge DAPT na nnwale enweghị usoro na-atụnyere BMS na DES. metụtarakarị mmerụ ahụ ọgwụgwọ na ihe ndị metụtara ịwa ahụ.
Taa, a na-elekwasị anya na ST n'oge/n'oge dị oke njọ. Ọ bụ ezie na ihe ndị dị na usoro na teknụzụ yiri ka ha na-arụ ọrụ dị ukwuu na mmepe nke ST dị oke njọ na nke dị ala, usoro nke ihe ndị na-eme ka thrombotic na-egbu oge yiri ka ọ dị mgbagwoju anya karịa. A na-atụ aro na ụfọdụ njirimara ndị ọrịa nwere ike ịbụ ihe egwu maka ST na-aga n'ihu na nke dị oke njọ: ọrịa shuga mellitus, ACS n'oge ịwa ahụ mbụ, ọdịda akụrụ, afọ ndụ, mbelata nke ejection fraction, nnukwu ihe omume obi ọjọọ n'ime ụbọchị 30 nke ịwa ahụ mbụ. Maka BMS na DES, mgbanwe usoro dị ka obere nha arịa ọbara, bifurcations, ọrịa multivascular, calcification, mkpọchi zuru oke, stents ogologo yiri ka ejikọtara ya na ihe egwu nke ST na-aga n'ihu. 62,63 Nzaghachi na-adịghị mma na ọgwụgwọ antiplatelet bụ nnukwu ihe egwu maka thrombosis DES na-aga n'ihu 51. Nzaghachi a nwere ike ịbụ n'ihi enweghị nrubeisi nke onye ọrịa, oke dose, mmekọrịta ọgwụ, ihe ndị na-akpata mmeghachi omume ọgwụ, polymorphism mkpụrụ ndụ ihe nketa nke ndị nnata (karịsịa iguzogide clopidogrel), na ịgbalite ụzọ ndị ọzọ maka mkpali platelet. A na-ewere Stent neoatherosclerosis dị ka usoro dị mkpa maka ọdịda stent n'oge, gụnyere ST64 nke ikpeazụ (ngalaba "Stent Neoatherosclerosis"). Endothelium ahụ na-adịghị agwụ agwụ na-ekewa mgbidi arịa thrombosis na ogidi stent site n'ọbara ma na-ewepụta ihe ndị na-egbochi thrombosis na vasodilatory. DES na-ekpughe mgbidi arịa ahụ nye ọgwụ mgbochi mmụba na ikpo okwu mwepụta ọgwụ, yana mmetụta dị iche iche na ọgwụgwọ na ọrụ endothelial, yana ihe egwu nke thrombosis n'oge ikpeazụ. 65 Ọmụmụ ihe gbasara ọrịa egosila na polymer DES nke ọgbọ mbụ siri ike nwere ike itinye aka na mbufụt na-adịghị ala ala, nkwụnye fibrin na-adịghị ala ala, ọgwụgwọ endothelial na-adịghị mma, na n'ihi ya na-abawanye ohere nke thrombosis. 3 Mmetụta mberede na DES yiri ka ọ bụ usoro ọzọ na-eduga na ST. Virmani et al. [66] kọrọ nchọpụta mgbe ST gasịrị na-egosi mmụba nke aneurysm na ngalaba stent yana mmeghachi omume hypersensitivity mpaghara nke gụnyere T-lymphocytes na eosinophils; nchọpụta ndị a nwere ike igosipụta mmetụta nke polymers a na-apụghị ibibi ebibi. 67 Nkwụsị Stent nwere ike ịbụ n'ihi mmụba stent na-adịghị mma ma ọ bụ mee ọnwa ole na ole ka PCI gasịrị. Ọ bụ ezie na nsogbu usoro bụ ihe egwu maka ST dị oke njọ na nke dị ala, mkpa ahụike nke nsogbu stent enwetara nwere ike ịdabere na mgbanwe akwara siri ike ma ọ bụ ọgwụgwọ egbu oge nke ọgwụ kpatara, mana mkpa ya na ahụike na-arụ ụka. 68
Mmetụta nchebe nke DES nke ọgbọ nke abụọ nwere ike ịgụnye endothelialization ngwa ngwa na nke na-adịgide adịgide, yana ọdịiche dị na stent alloy na nhazi, ọkpụrụkpụ strut, njirimara polymer, na ụdị ọgwụ mgbochi proliferative, dose, na kinetics.
Ma e jiri ya tụnyere CoCr-EES, ihe mkpuchi stent cobalt-chromium dị gịrịgịrị (81 µm), fluoropolymers antithrombotic, obere ọdịnaya polymer, na ibu ọgwụ nwere ike itinye aka na mbelata ọnụego ST. Ọmụmụ ihe nnwale egosila na thrombosis na platelet deposition dị obere nke ukwuu na stents ndị a kpuchiri fluoropolymer karịa na stents ndị a na-ekpuchighị ekpuchi. 69 Ma DES ọgbọ nke abụọ ndị ọzọ nwere ihe ndị yiri ya kwesịrị ịmụkwu ihe.
Ngwugwu akwara obi na-eme ka ọgwụgwọ akwara obi ka mma ma e jiri ya tụnyere ọgwụgwọ akwara obi nke percutaneous transluminal coronary angioplasty (PTCA), nke nwere nsogbu mekaniki (mkpuchi vascular, dissection, wdg) na oke restenoses (ruo 40–50% nke ikpe). Ka ọ na-erule ngwụcha afọ 1990, e jiri BGM implant mee ihe fọrọ nke nta ka ọ bụrụ 70% nke PCI. 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BMSAgbanyeghị, n'agbanyeghị ọganihu na teknụzụ, usoro, na ọgwụgwọ, ihe egwu nke restenosis mgbe etinyere BMS dị ihe dị ka 20%, yana ọnụego gafere 40% na ụfọdụ obere ndị otu. 71 N'ozuzu, ọmụmụ ihe ahụike egosila na restenosis mgbe etinyere BMS, nke yiri nke a na-ahụ na PTCA nkịtị, na-arị elu na ọnwa 3-6 ma na-akwụsị na otu afọ. 72
DES na-ebelatakwa ọnụego ISR,73 ọ bụ ezie na mbelata a dabere na angiographic na ahụike. Mkpuchi polima DES na-ewepụta ihe ndị na-egbochi mbufụt na mgbochi mmụba, na-egbochi mmepe nke neointima, ma na-egbu oge mmezi akwara site na ọnwa ma ọ bụ afọ.74 N'ọmụmụ ihe gbasara ahụike na histological, a hụla uto neointima na-adịgide adịgide n'ime oge nlele anya ogologo mgbe etinyere DES, ihe a maara dị ka "ịnyachi azụ" 75.
Mmerụ ahụ akwara n'oge PCI na-ebute usoro dị mgbagwoju anya nke mbufụt na ndozi n'ime obere oge (izu ruo ọnwa), na-ebute endothelialization na mkpuchi neointimal. Dịka nchọpụta histopathological si kwuo, neointimal hyperplasia (HMS na DES) mgbe etinyere stent n'ime ihe mejupụtara ya bụ mkpụrụ ndụ akwara dị nro na-agbasa na proteoglycan-rich extracellular matrix. 70
Ya mere, neointimal hyperplasia bụ usoro ndozi nke gụnyere ihe ndị na-akpata coagulation na mbufụt, yana mkpụrụ ndụ ndị na-akpali mmụba nke mkpụrụ ndụ akwara dị nro na nhazi matrix extracellular. Ozugbo PCI gasịrị, a na-etinye platelets na fibrin na mgbidi arịa ahụ ma na-adọta leukocytes site na usoro nke mkpụrụ ndụ njikọta sel. Leukocytes na-atụgharị na-arapara na platelets ejikọtara site na mmekọrịta dị n'etiti leukocyte integrin Mac-1 (CD11b/CD18) na platelet glycoprotein Ibα 53 ma ọ bụ fibrinogen nke jikọtara ya na platelet glycoprotein IIb/IIIa. 76.77
Dịka data ọhụrụ si kwuo, mkpụrụ ndụ progenitor ọkpụkpụ na-etinye aka na mmeghachi omume akwara na usoro ndozi. Ịkwalite EPC site na ụmị ọkpụkpụ gaa na ọbara dị n'akụkụ na-akwalite mmụgharị endothelial na neovascularization mgbe amuchara nwa. O yiri ka mkpụrụ ndụ progenitor akwara dị nro (SMPCs) na-akwaga ebe mmerụ ahụ akwara dị, na-ebute mmụba neointimal. 78 Na mbụ, a na-ewere mkpụrụ ndụ CD34-positive dị ka ọnụ ọgụgụ nkịtị nke EPCs, ọmụmụ ihe ndị ọzọ egosila na antigen elu CD34 na-amata mkpụrụ ndụ stem ọkpụkpụ na-enweghị ọdịiche nwere ikike ịmata ọdịiche dị na EPCs na PBMCs. Mgbanwe nke mkpụrụ ndụ CD34-positive n'ime usoro EPC ma ọ bụ SMPC dabere na gburugburu ebe obibi; ọnọdụ ischemic na-akpali ọdịiche dị na phenotype EPC, nke na-akwalite reendothelialization, ebe ọnọdụ mkpali na-akpali ọdịiche dị na SMPC phenotype, nke na-akwalite mmụba neointimal. 79
Ọrịa shuga na-eme ka ohere nke ISR dịkwuo elu site na 30–50% mgbe etinyere BMS n'ime ahụ, oke nke restenosis n'ime ndị ọrịa nwere ọrịa shuga dịkwagidere n'oge DES. Usoro ndị dị n'okpuru ihe a na-ahụ nwere ike ịbụ ọtụtụ ihe, gụnyere sistemụ (dịka ọmụmaatụ, mgbanwe na nzaghachi mbufụt) na anatomical (dịka ọmụmaatụ, obere arịa ọbara, ọnya ndị dị ogologo, ọrịa na-agbasa, wdg), nke na-eme ka ohere nke ISR dịkwuo elu n'onwe ya. 70
Dayameta na ogologo mmerụ ahụ metụtara ọnụego ISR n'adabereghị onwe ya, yana obere dayameta/obere mmerụ ahụ na-eme ka ọnụego restenosis dịkwuo elu nke ukwuu ma e jiri ya tụnyere nnukwu dayameta/obere mmerụ ahụ. 71
Ngwugwu stent nke ọgbọ mbụ gosiri stent struts dị arọ na ISR dị elu ma e jiri ya tụnyere ngwugwu stent nke ọgbọ nke abụọ nwere stut dị gịrịgịrị.
Ọzọkwa, a na-ejikọkarị restenosis na ogologo stent, nke fọrọ nke nta ka ọ bụrụ okpukpu abụọ maka ogologo stent karịrị 35 mm ma e jiri ya tụnyere ndị na-erughị 20 mm. Ọzọkwa, a na-ejikọkarị ọrịa restenosis na ogologo stent, nke fọrọ nke nta ka ọ bụrụ okpukpu abụọ maka ogologo stent karịrị 35 mm ma e jiri ya tụnyere ndị na-erughị 20 mm. Кроме того, частота рестеноза связана с длиной стента, почти удваиваясь при >35 stenta <20 mm. Tinyere nke ahụ, ọnụego nke restenosis metụtara ogologo stent, nke fọrọ nke nta ka ọ bụrụ okpukpu abụọ ka ogologo stent karịrị 35 mm ma e jiri ya tụnyere ogologo stent karịrị 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 的两关此外，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 больтим . Tinyere nke ahụ, ugboro ole a na-eme restenosis dabere n'ogologo nke stent ahụ: ogologo stent ahụ karịrị 35 mm fọrọ nke nta ka ọ bụrụ okpukpu abụọ nke stent ahụ karịa 20 mm.Dayameta lumen kacha nta ikpeazụ nke stent ahụ rụkwara ọrụ dị mkpa: obere dayameta lumen kacha nta ikpeazụ buru amụma na ihe egwu nke restenosis ga-abawanye nke ukwuu. 81.82
Dịka ọ dị na mbụ, a na-ewere hyperplasia intimal mgbe etinyere BMS ka ọ kwụsiri ike, yana oke mmalite n'etiti ọnwa isii na otu afọ wee soro oge ezumike n'oge. A kọọla na mbụ na uto intimal na-esote nlọghachi intimal na mmụba lumen; a tụrụ aro ntozu nke mkpụrụ ndụ akwara dị nro na mgbanwe na matrix extracellular dị ka usoro enwere ike maka nlọghachi neointima late. 83 Agbanyeghị, ọmụmụ ihe ndị na-esochi ogologo oge egosila mmeghachi omume triphasic mgbe etinyechara BMS na restenosis mbụ, nlọghachi intimal, na restenosis late luminal. 84
N'oge DES, e gosipụtara uto neointimal n'oge ikpeazụ mgbe etinyere SES ma ọ bụ PES n'ime ụdị anụmanụ. 85 Ọtụtụ nnyocha IVUS egosila mbelata mmalite nke uto intimal na-esote ya na-esote n'oge na-esote mgbe etinyere SES ma ọ bụ RPE, ikekwe n'ihi usoro mkpali na-aga n'ihu.86
N'agbanyeghị "nkwụsi ike" a na-ejikarị eme ihe na ISR, ihe dị ka otu ụzọ n'ụzọ atọ nke ndị ọrịa nwere BMS ISR na-enweta ACS.
E nwere ihe akaebe na-egosi na mbufụt na-adịghị ala ala na/ma ọ bụ enweghị ike zuru oke nke endothelial na-akpata neoatherosclerosis na-aga n'ihu na HCM na DES (karịsịa DES nke ọgbọ mbụ), nke nwere ike ịbụ usoro dị mkpa maka mmepe nke IR na-aga n'ihu ma ọ bụ ST na-aga n'ihu. Inoue et al [87] kọrọ nchọpụta nyocha nke histological mgbe etinyere Palmaz-Schatz coronary stents, na-atụ aro na mbufụt gburugburu stent nwere ike ịkpalite mgbanwe atherosclerotic ọhụrụ na-adịghị mma n'ime stent. Ọmụmụ ihe ndị ọzọ10 egosila na anụ ahụ restenotic n'ime afọ 5 CGM gụnyere atherosclerosis mmalite ọhụrụ nwere ma ọ bụ na-enweghị mbufụt peritoneal; ihe atụ sitere na ikpe ACS na-egosi ihe ndị na-adịghị ike na akwara obi obodo Ọdịdị ngọngọ histological yana macrophages foamy na kristal cholesterol. Na mgbakwunye, mgbe a na-atụnyere BMS na DES, a hụrụ nnukwu ọdịiche na oge na mmepe nke atherosclerosis ọhụrụ. 11,12 Mgbanwe atherosclerotic mbụ na nbanye macrophage nke ụfụfụ malitere ọnwa anọ ka etinyere SES, ebe mgbanwe ndị ahụ na mmerụ ahụ CGM mere mgbe afọ abụọ gachara ma ka bụrụ ihe a na-ahụkarị ruo afọ anọ. Na mgbakwunye, DES stenting maka mmerụ ahụ na-adịghị akwụsi ike dịka obere tegmental fibroatherosclerosis (TCFA) ma ọ bụ mgbawa intimal nwere obere oge mmepe ma e jiri ya tụnyere BMS. Ya mere, neoatherosclerosis yiri ka ọ na-adịkarị ma na-eme na mbụ na DES nke ọgbọ mbụ karịa na BMS, ikekwe n'ihi ọrịa dị iche.
Mmetụta nke ọgbọ nke abụọ DES ma ọ bụ DES nwere n'ihe gbasara mmepe ka dị mkpa; ọ bụ ezie na ụfọdụ ihe ndị e kwurula banyere ọgbọ nke abụọ DES88 na-egosi obere mbufụt, ihe gbasara neoatherosclerosis yiri nke ọgbọ nke mbụ, mana a ka chọrọ ọmụmụ ihe ndị ọzọ.