I-Javascript okwamanje ikhutshaziwe kusiphequluli sakho. Ezinye izici zale webhusayithi ngeke zisebenze uma i-JavaScript ikhutshaziwe.
Bhalisa ngemininingwane yakho ethile kanye nomuthi othize owuthandayo, futhi sizofanisa ulwazi olunikezayo nezihloko eziku-database yethu ebanzi bese sikuthumelela ikhophi ye-PDF nge-imeyili ngokushesha.
UMarta Francesca Brancati, 1 Francesco Burzotta, 2 Carlo Trani, 2 Ornella Leonzi, 1 Claudio Cuccia, 1 Filippo Crea2 1 UMnyango Wezifo Zenhliziyo, Isibhedlela iPoliambulanza Foundation, eBrescia, 2 UMnyango Wezifo Zenhliziyo, iCatholic University of the Sacred Heart of Rome, e-Italy Isifinyezo: Ama-Drug Stents ambozwe (DES) anciphisa imikhawulo yokusebenzisa ama-stents ensimbi angenalutho (BMS) ngemva kokungenelela kwe-percutaneous coronary. Kodwa-ke, ngenkathi ukwethulwa kwe-DES yesizukulwane sesibili kubonakala sengathi kuye kwehlisa lesi simo uma kuqhathaniswa ne-DES yesizukulwane sokuqala, ukukhathazeka okukhulu kusasele mayelana nezinkinga ezingaba khona kamuva zokufakelwa kwe-stent njenge-stent thrombosis (ST) kanye nokususwa kwe-stent, i-stenosis (SSI). I-ST iyisenzakalo esingaba yinhlekelele esincishiswe kakhulu ngokufakelwa kwe-stent okulungiselelwe, ukwakheka kwe-stent okusha, kanye nokwelashwa okubili kwe-antiplatelet. Indlela eqondile echaza ukwenzeka kwayo isaphenywa, futhi empeleni izici eziningana ziyimbangela. I-ISR ku-BMS ngaphambili yayibhekwa njengesimo esizinzile esinezinga eliphezulu lokuqala le-intimal hyperplasia (ezinyangeni eziyi-6) kulandelwe isikhathi sokubuyela emuva esingaphezu konyaka owodwa. Ngokuphambene nalokho, kokubili izifundo zezokwelapha neze-histological ze-DES zibonise ubufakazi bokukhula okuqhubekayo kwe-neointimal esikhathini eside sokulandelela, into eyaziwa ngokuthi i-"late catch-up" phenomenon. Umbono wokuthi i-ISR iyisimo sezokwelapha esingenabungozi usanda kuphikiswa ubufakazi bokuthi iziguli ezine-ISR zingase zibe ne-acute coronary syndromes. I-Intracoronary imaging iyindlela ehlaselayo yokuhlonza ama-plaque e-atherosclerotic ane-stented kanye nezimpawu zokuphulukiswa kwemithambo yegazi ngemva kokuthola i-stenting, futhi ivame ukusetshenziselwa ukuqedela i-coronary angiography yokuxilonga nokwenza izinqubo zokungenelela. I-Intracoronary optical coherence tomography okwamanje ibhekwa njengendlela yokuthwebula ethuthukisiwe kakhulu. Ihlinzeka, uma kuqhathaniswa ne-ultrasound yangaphakathi kwemithambo yegazi, isisombululo esingcono (okungenani izikhathi ezingaphezu kweziyi-10), okuvumela ukucaciswa okuningiliziwe kwesakhiwo esingaphezulu sodonga lwemithambo yegazi. Ihlinzeka, uma kuqhathaniswa ne-ultrasound yangaphakathi kwemithambo yegazi, isisombululo esingcono (okungenani izikhathi ezingaphezu kweziyi-10), okuvumela ukucaciswa okuningiliziwe kwesakhiwo esingaphezulu sodonga lwemithambo yegazi. оно обеспечивает, по сравнению с внутрисосудистым УЗИ, лучшее разрешение (по крайней мере, >10 раз), что позволяет деавальшение озрузей структуру стенки сосуда. Uma kuqhathaniswa ne-ultrasound yangaphakathi kwemithambo yegazi, inikeza isisombululo esingcono (okungenani izikhathi ezingaphezu kweziyi-10), okuvumela ukucaciswa okuningiliziwe kwesakhiwo sobuso bodonga lwemithambo yegazi.与血管内超声相比，它提供了更好的分辨率（至面少> 10 倍），允许详细表征血的管时。与血管内超声相比，它提供了更好的分辨率（至面少> 10），允许详细表征血管壁。Uma kuqhathaniswa ne-ultrasound yangaphakathi kwemithambo yegazi, inikeza isisombululo esingcono (okungenani izikhathi eziyi-10), okuvumela ukucaciswa okuningiliziwe kwesakhiwo sobuso bodonga lwemithambo yegazi.Izifundo zokuthatha izithombe ze-in vivo ezihambisana nokutholakele kwe-histological zisikisela ukuthi ukuvuvukala okungapheli kanye/noma ukungasebenzi kahle kwe-endothelial kungabangela i-neoatherosclerosis ethuthukisiwe ku-HMS kanye ne-DES. Ngakho-ke, i-neoatherosclerosis isibe yisisulu esiyinhloko ekuveleni kwe-pathogenesis yokwehluleka kwe-stent kwakamuva. Amagama ayisihluthulelo: i-coronary stent, i-stent thrombosis, i-restenosis, i-neoatherosclerosis.
Ukungenelela kwe-percutaneous coronary okune-stent (PCI) kuyindlela esetshenziswa kakhulu ekwelapheni isifo semithambo yenhliziyo esinezimpawu, futhi le ndlela iyaqhubeka nokukhula. 1 Nakuba ama-drug eluting stents (DES) enciphisa ukulinganiselwa kwama-uncoated stents (UES), izinkinga ezifika sekwephuzile njenge-stent thrombosis (ST) kanye ne-stent restenosis (ISR) zingase zenzeke ngokufakelwa kwe-stent, futhi kusekhona ukukhathazeka okukhulu. 2-5
Uma i-ST iyisenzakalo esingaba yinhlekelele, ukwamukelwa kokuthi i-ISR iyisifo esingenabungozi kuye kwaphikiswa muva nje ubufakazi be-acute coronary syndrome (ACS) ezigulini ezine-ISR.
Namuhla, i-intracoronary optical coherence tomography (OCT)6-9 ibhekwa njengendlela yokuthwebula izithombe yesimanje enikeza isisombululo esingcono kune-intravascular ultrasound (IVUS). Izifundo zokuthwebula izithombe ze-in vivo10-12 ezihambisana nokutholakele kwe-histological zibonisa indlela "entsha" yokuphendula imithambo yegazi ngemva kokufakelwa kwe-stent nge-de novo "neoatherosclerosis" ngaphakathi kwe-BMS ne-DES.
Ngo-1964 uCharles Theodore Dotter noMelvin P. Judkins bachaza i-angioplasty yokuqala. Ngo-1978, u-Andreas Grunzig wenza i-angioplasty yokuqala yebhaluni (i-angioplasty yakudala yebhaluni evamile); kwakuyindlela yokwelapha eshintshashintshayo, kodwa futhi yayinezinkinga zokuvalwa kwemithambo yegazi okubukhali kanye ne-restenosis. 13 Lokhu kwaholela ekutholakaleni kwama-stents enhliziyo: UPuel noSigwart bafaka i-stent yokuqala yenhliziyo ngo-1986, banikeza i-stent yokuvimbela ukuvalwa kwemithambo yegazi okubukhali kanye nokuhoxa kwe-systolic sekwephuzile. 14 Nakuba la ma-stents okuqala avimbela ukuvalwa kwemithambo yegazi ngokuzumayo, abangela umonakalo omkhulu we-endothelial kanye nokuvuvukala. Muva nje, izifundo ezimbili ezibalulekile, i-Belgian-Dutch Stent Study 15 kanye ne-Stent Restenosis Study 16, zikhuthaze ukuphepha kwe-stent ye-antiplatelet therapy (DAPT) kanye/noma izindlela ezifanele zokufakwa. 17,18 Ngemva kwalezi zivivinyo, inani lama-PCI enziwe landa kakhulu.
Kodwa-ke, inkinga ye-iatrogenic in-stent neointima hyperplasia ngemva kokubekwa kwe-BMS yatholakala ngokushesha, okwaholela ku-ISR ku-20-30% wezilonda ezelashwe. I-DES19 yethulwa ngo-2001 ukuze kuncishiswe isidingo sokuphumula nokuhlinzwa kabusha. I-DES ikhulise ukuzethemba kodokotela benhliziyo ngokuvumela ukwelashwa kwenani elikhulayo lezilonda eziyinkimbinkimbi ezazibhekwa njengezelapheka ngaphambilini nge-coronary artery bypass grafting. Ngo-2005, ama-80-90% awo wonke ama-PCI ayehambisana ne-DES.
Konke kunezinkinga zako, futhi kusukela ngo-2005 ukukhathazeka ngokuphepha kwe-DES “yesizukulwane sokuqala” kuye kwanda, ama-stents esizukulwane esisha afana nama-20,21 athuthukiswe futhi angeniswa. 22 Kusukela ngaleso sikhathi, imizamo yokuthuthukisa ukusebenza kwama-stents ikhule ngokushesha, futhi ubuchwepheshe obusha obujabulisayo buqhubekile nokutholwa futhi bulethwa ngokushesha emakethe.
I-BMS iyipayipi elihle le-wire mesh. Ngemva kokuhlangenwe nakho kokuqala nge-Wall mount, i-Gianturco-Roubin mount kanye ne-Palmaz-Schatz mount, ama-BMS amaningi ahlukahlukene manje aseyatholakala.
Kunezinhlobo ezintathu ezahlukene zemiklamo: i-serpentine, i-tube mesh kanye ne-slots tube. Imiklamo ye-coil iqukethe izintambo zensimbi noma imichilo eyakha isimo se-coil esiyindilinga; kumiklamo ye-tube mesh, intambo ehlanganiswe ndawonye ibe yi-mesh yakha i-tube; imiklamo ye-slots iqukethe ama-tube ensimbi asikwa nge-laser. Lawa madivayisi ayahlukahluka ngokwakheka (insimbi engagqwali, i-nichrome, i-cobalt chrome), ukwakheka (izimo ezahlukahlukene ze-spacer nobubanzi, ububanzi nobude, amandla e-radial, i-radiopacity), kanye nezinhlelo zokulethwa (ezizikhulisayo noma ezinwebekayo ngebhaluni).
Njengomthetho, i-BMS entsha iqukethe i-alloy ye-cobalt-chromium, okuholela ezintanjeni ezincane, ukusebenza okuthuthukisiwe kokushayela kanye namandla okusebenza agcinwe.
Ziqukethe ipulatifomu ye-stent yensimbi (ngokuvamile insimbi engagqwali) futhi zimbozwe nge-polymer ekhipha izinto zokwelapha ezilwa nokwanda kanye/noma ezilwa nokuvuvukala.
I-Sirolimus (eyaziwa nangokuthi i-rapamycin) yasungulwa ekuqaleni njenge-ejenti yokulwa ne-fungus. Indlela yayo yokusebenza ihlotshaniswa nokuvimba ukuqhubeka komjikelezo weseli ngokuvimbela ukuguquka kusuka esigabeni se-G1 kuya esigabeni se-S nokuvimbela ukwakheka kwe-neointima. Ngo-2001, isipiliyoni "somuntu wokuqala" nge-SES sabonisa imiphumela ethembisayo, okwaholela ekuthuthukisweni kwe-stent ye-Cypher. 23 Izilingo ezinkulu zibonise ukusebenza kwayo ekuvimbeleni i-IR. 24
I-Paclitaxel yavunywa ekuqaleni ekwelapheni umdlavuza wesibeletho, kodwa izakhiwo zayo ezinamandla ze-cytostatic—umuthi uqinisa ama-microtubules ngesikhathi se-mitosis, ubangela ukumiswa komjikelezo weseli, futhi uvimbele ukwakheka kwe-neointimal—wenza kube yinhlanganisela ye-Taxus Express PES. Izivivinyo ze-TAXUS V kanye ne-VI zibonise ukusebenza kahle kwesikhathi eside kwe-PES ezifweni zenhliziyo eziyinkimbinkimbi eziyingozi kakhulu. 25,26 I-TAXUS Liberté eyalandela yayineplatifomu yensimbi engagqwali ukuze kube lula ukulethwa.
Ubufakazi obuqinile obuvela ekubuyekezweni okuhlelekile okubili kanye nokuhlaziywa kwe-meta kusikisela ukuthi i-SES inenzuzo kune-PES ngenxa yamazinga aphansi e-IVR kanye ne-target vessel revascularization (TVA), kanye nokuthambekela kokwanda kwe-acute myocardial infarction (AMI) eqenjini le-PES. 27.28
Amadivayisi esizukulwane sesibili anobukhulu obunciphile bomgodi, ukuguquguquka/ukulethwa okuthuthukisiwe, amaphrofayili okuhambisana kwe-polymer/ukususwa kwezidakamizwa okuthuthukisiwe, kanye ne-kinetics yokuvuselela kabusha engcono kakhulu. Emsebenzini wamanje, lawa amadizayini e-DES athuthuke kakhulu kanye nama-stents amakhulu e-coronary afakwe emhlabeni jikelele.
I-Taxus Elements ithatha lesi sinyathelo esisodwa phambili nge-polymer ehlukile eyenzelwe ukukhishwa kusenesikhathi okuphezulu kanye nesistimu entsha ye-platinum-chromium spacer enikeza ama-spacer amancane kanye ne-radiopacity eyandisiwe. Ucwaningo lwe-PERSEUS 29 luphawule imiphumela efanayo phakathi kwe-Element ne-Taxus Express kuze kube yizinyanga eziyi-12. Kodwa-ke, azikho izivivinyo ezanele zokuqhathanisa izakhi ze-yew nezinye izizukulwane ze-DESS.
I-Endeavor Zotarolimus Coated Stent (ZES) isekelwe epulatifomu eqinile ye-cobalt-chromium stent enokuguquguquka okuphezulu kanye ne-stent strut encane. I-Zotarolimus iyi-analogue ye-sirolimus enemiphumela efanayo yokucindezela amasosha omzimba, kodwa ikhuphula i-lipophilicity ukuthuthukisa indawo odongeni lwemithambo yegazi. I-ZES isebenzisa i-polymer coating entsha ye-phosphorylcholine eyenzelwe ukwandisa ukuhambisana kwezinto eziphilayo nokunciphisa ukuvuvukala. Imithi eminingi igezwa esigabeni sokuqala sokulimala, kulandelwa ukulungiswa kwemithambo yegazi. Ngemuva kwesilingo sokuqala se-ENDEAVOR, isilingo esilandelayo se-ENDEAVOR III saqhathanisa i-ZES ne-SES, ebonise ukulahlekelwa okuphezulu kwe-lumen sekwephuzile kanye ne-HR kodwa kunezehlakalo ezimbalwa ezimbi kakhulu zenhliziyo (MACEs) kune-SES. 30 Ucwaningo lwe-ENDEAVOR IV oluqhathanisa i-ZES ne-PES luphinde lwathola ukwanda okuphezulu kwe-SIS kodwa ukwanda okuphansi kwe-MI, okungenzeka ukuthi kungenxa ye-ST evame kakhulu eqenjini le-ZES. 31 Kodwa-ke, ucwaningo lwe-PROTECT lwehlulekile ukukhombisa umehluko ekuvameni kwe-ST phakathi kwe-Endeavor ne-Cypher stents. 32
I-Endeavor Resolute iyinguqulo ethuthukisiwe ye-stent ye-Endeavor ene-polymer entsha enezingqimba ezintathu. I-Resolute Integrity entsha (ngezinye izikhathi ebizwa ngokuthi i-DES yesizukulwane sesithathu) isekelwe epulatifomu entsha enamakhono aphezulu okulethwa (ipulatifomu ye-Integrity BMS) kanye ne-polymer entsha, ehambisana kakhulu ne-bio enezingqimba ezintathu engacindezela impendulo yokuqala yokuvuvukala futhi isuse umuthi omningi ezinsukwini ezingama-60 ezizayo. Ukuhlolwa okuqhathanisa i-Resolute ne-Xience V (i-everolimus eluting stent [EES]) kubonise ukuthi uhlelo lwe-Resolute lwalusebenza ngokulinganayo maqondana nokufa kanye nokwehluleka kwesilonda esiqondiwe. 33.34
I-Everolimus, i-sirolimus derivative, iphinde ibe yi-cell cycle inhibitor esetshenziswa ekuthuthukisweni kwe-EES Xience (ipulatifomu ye-Multi-link Vision BMS)/Promus (ipulatifomu ye-Platinum Chromium). Isivivinyo se-SPIRIT 35-37 sibonise imiphumela ethuthukisiwe futhi sanciphisa i-MACE nge-Xience V uma kuqhathaniswa ne-PES, kuyilapho isivivinyo se-EXCELLENT sibonise ukuthi i-EES yayinhle njenge-SES ekucindezeleni ukulahlekelwa sekwephuzile ezinyangeni ezingu-9 kanye nemicimbi yezokwelapha ezinyangeni ezingu-12. 38 Okokugcina, i-stent ye-Xience iboniswe ukuthi ingcono kune-BMS esimweni se-ST elevation myocardial infarction (MI). 39
Ama-EPC ayiqembu lamaseli ajikelezayo ahilelekile ekulungisweni kwe-vascular homeostasis kanye nokulungiswa kwe-endothelial. Ukwanda kwe-EPC endaweni yokulimala kwemithambo yegazi kuzokhuthaza ukuvuselelwa kabusha kwe-endothelialization kusenesikhathi, okungenzeka kunciphise ingozi ye-ST. Ukungena kokuqala kwe-EPC Biology ekwakhiweni kwe-stent yi-Genous stent, embozwe ngama-anti-CD34 antibodies, ekwazi ukubopha ama-EPC ajikelezayo ngama-hematopoietic markers ayo ukuze kuthuthukiswe ukuvuselelwa kabusha kwe-endothelialization. Ngenkathi izifundo zokuqala bezikhuthaza, ubufakazi bamuva bukhomba amazinga aphezulu e-TVR. 40
Njengoba kunikezwe imiphumela engaba yingozi yokuphulukiswa okubambezelekile okubangelwa yi-polymer okuhlotshaniswa nengozi ye-ST, ama-polymer angaphili kahle anikeza izinzuzo ze-DES ngokugwema ukukhathazeka okuhlala isikhathi eside mayelana nokuphikelela kwe-polymer. Kuze kube manje, izinhlelo ezahlukahlukene ezingaphili kahle ziye zavunyelwa (isb., i-Nobori ne-Biomatrix, i-biolimus eluting stent, i-Synergy, i-EES, i-Ultimaster, i-SES), kodwa izincwadi ezisekela imiphumela yazo yesikhathi eside zilinganiselwe. 41
Izinto ezimuncwa yizinto eziphilayo zinenzuzo yethiyori yokunikeza ukwesekwa kwemishini ekuqaleni lapho kubhekwa ukugoba kwe-elastic nokunciphisa izingozi zesikhathi eside ezihambisana nezinsimbi zensimbi ezikhona. Ubuchwepheshe obusha buholele ekuthuthukisweni kwama-polymer e-lactic acid (i-poly-l-lactic acid [PLLA]), kodwa izinhlelo eziningi ze-stent ziyathuthukiswa, yize ukuthola ibhalansi efanele phakathi kokususa izidakamizwa kanye ne-degradation kinetics kuseyinselele. Ucwaningo lwe-ABSORB lubonise ukuphepha nokusebenza kahle kwama-stents e-PLLA ambozwe yi-everolimus. 43 Ukubuyekezwa kwe-stent yesizukulwane sesibili ye-Absorb kwakungcono kuneyangaphambilini ngokulandelwa okuhle kweminyaka emi-2. 44 Ucwaningo lwamanje lwe-ABSORB II, isilingo sokuqala esingahleliwe esiqhathanisa i-stent ye-Absorb ne-stent ye-Xience Prime, kufanele lunikeze idatha eyengeziwe, futhi imiphumela yokuqala etholakalayo iyathembisa. 45 Kodwa-ke, izimo ezifanele, indlela efanele yokufaka, kanye nephrofayili yokuphepha esifweni semithambo yenhliziyo kudingeka kucaciswe.
I-Thrombosis kokubili ku-BMS kanye ne-DES inemiphumela emibi yezokwelapha. Kurejista yeziguli ezifakwe i-DES, ama-24% amacala e-ST abangele ukufa, ama-60% ku-MI engabulali, kanye nama-7% ku-angina engazinzile. I-PCI ye-ST ephuthumayo ivame ukuba yimbi kakhulu, kanti ukuphinda kuvele kuma-12% amacala. 48
I-ST enwetshiwe ingaba nemiphumela emibi yezokwelapha. Esifundweni se-BASKET-LATE, ezinyangeni eziyi-6-18 ngemuva kokufakwa kwe-stent, amazinga okufa kwenhliziyo kanye ne-MI engabulali ayephezulu eqenjini le-DES kunaseqenjini le-SMP (4.9% kanye no-1.3%, ngokulandelana). 20 Ukuhlaziywa kwe-meta-analysis kwezifundo eziyisishiyagalolunye lapho iziguli ezingu-5261 zahlelwa ngokungahleliwe ku-SES, PES, noma i-BMS kubonise ukuthi ngemva kweminyaka engu-4 yokulandelela, i-SES (0.6% uma kuqhathaniswa no-0%, p = 0.025) kanye ne-PES (0.7%) kwandisa izehlakalo ze-ST esephuzile kakhulu uma kuqhathaniswa ne-BMS ngo-0.2%, p = 0.028). 49 Ngokuphambene nalokho, ekuhlaziyweni kwe-meta okuhlanganisa iziguli ezingu-5108, kwabikwa ukwanda okungu-60% kokufa noma i-MI nge-SES uma kuqhathaniswa ne-BMS (p = 0.03), kuyilapho i-PES ihlotshaniswa nokwanda okungabalulekile okungu-15% (bheka - kuze kufike ezinyangeni ezingu-9 kuya eminyakeni emi-3).
Amarejista amaningi, izivivinyo ezingahleliwe, kanye nokuhlaziywa kwe-meta kuhlole ingozi ehlobene ye-ST ngemuva kokufakelwa kwe-BMS kanye ne-DES futhi kubike imiphumela engqubuzanayo. Kurejista yeziguli ezingu-6906 ezelashwe nge-BMS noma i-DES, bekungekho mehluko emiphumeleni yezokwelapha noma amazinga e-ST ngonyaka o-1 wokulandelela. 48 Kolunye uhlu lweziguli ezingu-8146, ingozi yokweqisa kwe-ST okuqhubekayo itholakale ingu-0.6% ngonyaka uma kuqhathaniswa ne-BMS. 49 Ukuhlaziywa kwe-meta kwezifundo eziqhathanisa i-SES noma i-PES nama-SMP kubonise ingozi eyengeziwe yokufa kanye ne-MI ne-DES yesizukulwane sokuqala uma kuqhathaniswa nama-SMP, angu-21 kanye nokuhlaziywa kwe-meta kweziguli ezingu-4545 ezihlelwe ku-SES noma ST phakathi kwe-PES ne-BMS eminyakeni engu-4 yokulandelela. 50 Ezinye izifundo zangempela zibonise ingozi eyengeziwe ye-ST ne-MI eqhubekayo ezigulini ezelashwe nge-DES yesizukulwane sokuqala ngemva kokuyekiswa kwe-DAPT. 51
Njengoba kunikezwe idatha ephikisanayo, ukuhlaziywa okuningana okuhlanganisiwe kanye nokuhlaziywa kwe-meta kunqume ukuthi i-DES kanye ne-SGM yesizukulwane sokuqala azifani kakhulu ngengozi yokufa noma i-MI, kodwa i-SES kanye ne-PES babenengozi eyengeziwe ye-ST evame kakhulu uma kuqhathaniswa ne-SGM. Ukuze kubukezwe ubufakazi obutholakalayo, i-US Food and Drug Administration (FDA) iqoke iphaneli lochwepheshe53 elikhiphe isitatimende esiqaphela ukuthi i-DES yesizukulwane sokuqala iyasebenza njengoba ibhalwe nokuthi ingozi yezigaba ezithuthukile kakhulu ze-ST incane, kodwa ayinkulu. , Ukwanda okukhulu. Ngenxa yalokho, i-FDA kanye nenhlangano batusa ukwelula isikhathi se-DAPT sibe unyaka owodwa, yize kunobufakazi obuncane bokusekela lesi simangalo.
Njengoba kushiwo ngaphambili, i-DES yesizukulwane sesibili iye yathuthukiswa ngezici zokuklama ezithuthukisiwe. I-CoCr-EES iye yadlula ocwaningweni olubanzi kakhulu lwezokwelapha. Ekuhlaziyweni kwe-meta okwenziwe nguBaber et al.54 kweziguli ezingu-17,101, i-CoCr-EES yehlise kakhulu i-ST ne-MI eqinisekile/engenzeka uma kuqhathaniswa ne-PES, SES, kanye ne-ZES ezinyangeni ezingu-21. Ekugcineni, uPalmeri et al ukhombisile ekuhlaziyweni kwe-meta kweziguli ezingu-16,775 ukuthi i-CoCr-EES ine-ST echazwe ekuqaleni, ngasekupheleni, yonyaka ongu-1 nowe-2 ephansi kakhulu uma kuqhathaniswa nezinye i-DES ezihlanganisiwe. Izifundo zangempela ezingu-55 zibonise ukwehla kwengozi ye-ST ne-CoCr-EES uma kuqhathaniswa ne-DES yesizukulwane sokuqala. 56
I-Re-ZES iqhathaniswa ne-CoCr-EES ezifundweni ze-RESOLUTE-AC kanye ne-TWENTE. 33,57 Kwakungekho mehluko obalulekile ekufeni, ekushayweni kwenhliziyo, noma esigabeni se-ST esichaziwe phakathi kwama-stents amabili.
Ekuhlaziyweni kwenethiwekhi kweziguli ezingu-50,844, kufaka phakathi ama-RCT angu-49, ama-58 e-CoCr-EES ahlotshaniswa nokwanda okuphansi kakhulu kwe-ST echaziwe kune-BMS, okutholakele okungabonakali kwamanye ama-DES; ukwehla akuzange kube "kusenesikhathi eside kakhulu" futhi ngemuva kwezinsuku ezingu-30 (58). isilinganiso samathuba [OR] 0.21, isikhawu sokuzethemba esingu-95% [CI] 0.11-0.42) kanye nonyaka o-1 (OR 0.27, 95% CI 0.08-0.74) kanye neminyaka emi-2 (OR 0.35, 95% CI 0.17–0.69). Uma kuqhathaniswa ne-PES, SES, kanye ne-ZES, i-CoCr-EES ihlotshaniswa nesilinganiso se-ST esiphansi ngonyaka o-1.
I-ST yokuqala ihlotshaniswa nezici ezahlukahlukene. Ukwakheka kwe-plaque eyisisekelo kanye nomthwalo we-thrombus kubonakala kuthonya umphumela ngemuva kwe-PCI; ukungena kwe-struts ezijulile ezingama-59 ngokuqubuka kwe-necrotic core (NC), ukudabuka okude kwe-medial ngaphakathi kwe-stent, i-stent engaphelele ene-residual edge dissections noma i-significant edge stenosis, i-apposition engaphelele, kanye nokwanda okungaphelele kwe-stent efakiwe kungandisa ingozi ye-ST.60 Uhlelo lokwelapha lwemithi ye-antiplatelet aluthinti kakhulu ukwanda kwe-ST yokuqala: esivivinyweni esingahleliwe esiqhathanisa ama-BMS nama-DESS, amazinga e-ST acute kanye ne-subacute ngesikhathi se-DAPT ayefana (<1%).61 Ngakho-ke, i-ST yokuqala ibonakala ihlobene kakhulu nezilonda ezingaphansi eziphathwe kanye nezici zenqubo. Ukwakheka kwe-plaque eyisisekelo kanye nomthwalo we-thrombus kubonakala kuthonya umphumela ngemuva kwe-PCI; ukungena kwe-struts ezijulile ezingama-59 ngokuwa kwe-necrotic core (NC), ukudabuka okude kwe-medial ngaphakathi kwe-stent, i-stent engaphelele ene-residual edge dissections noma i-significant edge stenosis, i-apposition engaphelele, kanye nokwanda okungaphelele kwe-stent efakiwe kungandisa ingozi ye-ST.60 Uhlelo lokwelapha lwemithi ye-antiplatelet aluthinti kakhulu ukwanda kwe-ST yokuqala: esivivinyweni esingahleliwe esiqhathanisa ama-BMS nama-DESS, amazinga e-ST acute kanye ne-subacute ngesikhathi se-DAPT ayefana (<1%) .61 Ngakho-ke, i-ST yokuqala ibonakala ihlobene kakhulu nezilonda ezingaphansi eziphathwe kanye nezici zenqubo. I-Морфология лежащей в основе бляшки and тромбоз, по-видимому, влияют на исход после ЧКВ;59 более глубокая пенетрация зраспор некротического ядра (NC), длинного медиального разрыва внутри стента, субоптимального стентирования с остаточными краевыми расслоениямильной звьям стенозом, неполной аппозицией и неполным расширением имплантированного стента может увеличить риск ST.60 существенного влияния на частоту раннего ST: в рандомизированном исследовании, сравнивающем BMS ne-DES, частота острого и подострого ST DA DA дибная (1%). .61 iTakim образом, ранняя ST, по-видимому, в первую очередь связана с лежащими в основе пролеченными поражениями и процедурными факторами. Ukwakheka kwe-plaque engaphansi kanye ne-thrombosis kubonakala kuthonya umphumela ngemuva kwe-PCI;59 ukungena okujulile kwe-strut ngenxa yokuwa kwe-necrotic nucleus (NC), ukudabuka okude kwe-medial ngaphakathi kwe-stent, i-stent engaphansi kwe-optimal ene-residual marginal delaminations noma i-significant marginal stenosis, i-apposition engaphelele kanye nokwanda okungaphelele kwe-stent efakiwe kungandisa ingozi ye-ST.60 Uhlelo lokwelapha lwemithi ye-antiplatelet aluthinti kakhulu ukwanda kwe-ST yokuqala: esivivinyweni esingahleliwe esiqhathanisa i-BMS ne-DES, ukwanda kwe-ST ebukhali kanye ne-subacute ngesikhathi se-DAPT kwakufana (<1%) .61 Ngakho-ke, i-ST yokuqala ibonakala ihlobene kakhulu nezilonda ezingaphansi eziphathwe kanye nezici zenqubo.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 的随机诚期间急性和亚急性ST 的发生率相似（<1%） .61 因此，早期ST 似乎主要与潜在的治疗旅因。潜在 的 斑块 形态 和血栓 似乎 影响 影响 pci 后 结果 ； ; ; ; ; ; ;脱垂 导致 的 支柱 穿透 、 内长 的 内侧 、 具有 残余 边缘 或 显着 边缘 独 次 次 次的 的 的 的 ,   , , , , , , .小板 药物的 治疗 方案 不 显着 影响 影响 早期的 ： 在 项 比较 比较 bms 与 中 期 ， 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 发生率相似（<1%） .61Ukwakheka kwe-plaque okuyisisekelo kanye ne-thrombosis kubonakala kuthonya imiphumela ngemuva kwe-PCI; 59 Ukungena okujulile kwe-strut ngenxa ye-necrotic nucleus (NC) prolapse, ukuqhekeka kwe-medial kubude be-stent, ukuhlukaniswa kwesibili okunemingcele eseleyo, noma ukunciphisa okukhulu kwemingcele Ukwehlisa i-stenting okuhle, ukufakwa okungaphelele, kanye nokwanda okungaphelele60 Uhlelo lwe-antiplatelet alunawo umthelela omkhulu ekutholakaleni kwe-ST kwasekuqaleni: ukusabalala kwe-ST ebukhali kanye ne-subacute ngesikhathi se-DAPT esivivinyweni esingahleliwe esiqhathanisa i-BMS ne-DES. kuhlobene kakhulu nezilonda zokwelapha eziyisisekelo kanye nezici zokuhlinzwa.
Namuhla, ukugxila kuse-ST sekwephuzile/sekwephuzile kakhulu. Nakuba izici zenqubo kanye nezobuchwepheshe zibonakala zidlala indima enkulu ekuthuthukisweni kwe-ST ebukhali neyi-subacute, indlela yokusebenza kwezehlakalo ze-thrombotic ezibambezelekile ibonakala iyinkimbinkimbi kakhulu. Kuye kwaphakanyiswa ukuthi izici ezithile zesiguli zingaba yizici eziyingozi ze-ST eqhubekayo nethuthuke kakhulu: isifo sikashukela, i-ACS ngesikhathi sokuhlinzwa kokuqala, ukwehluleka kwezinso, ukuguga, ingxenye yokukhipha encishisiwe, izehlakalo ezinkulu ezimbi zenhliziyo zingakapheli izinsuku ezingama-30 zokuhlinzwa kokuqala. Ku-BMS kanye ne-DES, izinguquko zenqubo ezifana nosayizi omncane wemithambo yegazi, ukuhlukana kwemithambo yegazi, isifo semithambo yegazi eminingi, i-calcification, ukuvaleka okuphelele, ama-stents amade kubonakala sengathi ahlotshaniswa nengozi ye-ST eqhubekayo. 62,63 Impendulo embi ekwelashweni kwe-antiplatelet iyisici esikhulu sengozi ye-thrombosis ye-DES eqhubekayo 51. Lokhu kusabela kungase kube ngenxa yokungalandeli imithetho yesiguli, ukungabi namthamo ofanele, ukusebenzisana kwezidakamizwa, izinkinga ezihambisanayo ezithinta impendulo yesidakamizwa, i-polymorphism yezakhi zofuzo ze-receptor (ikakhulukazi ukumelana ne-clopidogrel), kanye nokusebenza kwezinye izindlela zokusebenza kwe-platelet. I-Stent neoatherosclerosis ibhekwa njengendlela ebalulekile yokwehluleka kwe-stent sekwephuzile, kufaka phakathi i-ST64 sekwephuzile (isigaba esithi “Stent Neoatherosclerosis”). I-endothelium engashintshiwe ihlukanisa udonga lwemithambo yegazi olune-thrombosed kanye nezigxobo ze-stent egazini futhi ikhiphe izinto ezilwa nokuvuvukala kwegazi kanye ne-vasodilator. I-DES iveza udonga lwemithambo yegazi emithini yokulwa nokwanda kanye neplatifomu yokukhululwa kwemithi, enemiphumela ehlukahlukene ekwelapheni nasekusebenzeni kwe-endothelial, enengozi ye-thrombosis sekwephuzile. Izifundo ze-pathological ezingama-65 zibonise ukuthi ama-polymer e-DES aqinile esizukulwane sokuqala angafaka isandla ekuvuvukeni okungapheli, ukufakwa kwe-fibrin okungapheli, ukuphulukiswa okungekuhle kwe-endothelial, futhi ngenxa yalokho ingozi eyengeziwe ye-thrombosis. 3 Ukuzwela kwe-DES sekwephuzile kubonakala kungenye indlela eholela ku-ST. UVirmani et al. [66] babike okutholakele ngemuva kokufa ngemuva kwe-ST ekhombisa ukwanda kwe-aneurysm engxenyeni ye-stent ngokusabela kwe-hypersensitivity yendawo okuhlanganisa ama-T-lymphocytes nama-eosinophils; lokhu okutholakele kungabonisa ithonya lama-polymer angenakubhujiswa. 67 Ukungasebenzi kahle kwe-stent kungase kubangelwe ukwanda kwe-stent okungenaso isiqiniseko noma kwenzeke ezinyangeni ezimbalwa ngemva kwe-PCI. Nakuba ukungasebenzi kahle kwenqubo kuyisici esiyingozi se-ST ebukhali neyi-subacute, ukubaluleka kwezokwelapha kokungasebenzi kahle kwe-stent okutholiwe kungancika ekuguqulweni kabusha kwemithambo yegazi okunamandla noma ekuphulukisweni okulibazisekile okubangelwa izidakamizwa, kodwa ukubaluleka kwayo kwezokwelapha kuyaphikiswana. 68
Imiphumela yokuvikela ye-DES yesizukulwane sesibili ingafaka phakathi i-endothelialization esheshayo nengashintshi, kanye nomehluko ku-stent alloy kanye nesakhiwo, ubukhulu be-strut, izakhiwo ze-polymer, kanye nohlobo lwemithi yokulwa nokwanda, umthamo, kanye ne-kinetics.
Uma kuqhathaniswa ne-CoCr-EES, ama-scaffolds amancane (81 µm) e-cobalt-chromium stent, ama-fluoropolymer alwa nokuphazamiseka kwegazi, okuqukethwe okuphansi kwe-polymer, kanye nomthwalo wemithi kungabangela amazinga e-ST aphansi. Izifundo zokuhlola zibonise ukuthi i-thrombosis kanye nokufakwa kwama-platelet kuphansi kakhulu kuma-stents ambozwe yi-fluoropolymer kunakuma-stents angamboziwe. 69 Ukuthi amanye ama-DES esizukulwane sesibili anezakhiwo ezifanayo yini kufanele kufundwe kabanzi.
Ama-stents e-coronary athuthukisa impumelelo yokuhlinzwa kokungenelela kwe-coronary uma kuqhathaniswa ne-percutaneous transluminal coronary angioplasty yendabuko (i-PTCA), enezinkinga zemishini (ukuvaleka kwemithambo yegazi, ukuhlukaniswa kwegazi, njll.) kanye nesilinganiso esiphezulu se-restenosis (kufika ku-40-50% wamacala). Ekupheleni kweminyaka yama-1990, cishe ama-PCI angama-70% enziwa ngokufakelwa kwe-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云生特生亲给继继云入20% 40%.然而，尽管技术、技术和药物治疗取得了进步，但BMSKodwa-ke, naphezu kwentuthuko kwezobuchwepheshe, amasu, kanye nokwelashwa, ingozi ye-restenosis ngemuva kokufakelwa kwe-BMS cishe ingu-20%, kanti amazinga angaphezu kuka-40% emaqenjini athile amancane. 71 Ngokuvamile, izifundo zezokwelapha zibonise ukuthi i-restenosis ngemva kokufakelwa kwe-BMS, efana naleyo ebonwa nge-PTCA evamile, ifinyelela esicongweni ezinyangeni ezingu-3-6 futhi iphela ngonyaka ongu-1. 72
I-DES inciphisa amazinga e-ISR,73 yize lokhu kunciphisa kuncike ngokwe-angiography nangokwemitholampilo. I-DES polymer coating ikhipha ama-anti-inflammatory kanye nama-anti-proliferative agents, ivimbela ukwakheka kwe-neointima, futhi ibambezele ukulungiswa kwemithambo yegazi ngezinyanga noma iminyaka.74 Ezifundweni zemitholampilo neze-histological, ukukhula kwe-neointima okuqhubekayo kuye kwabonwa esikhathini eside sokulandelela ngemva kokufakelwa kwe-DES, into eyaziwa ngokuthi "ukubamba-ukufika sekwephuzile"75.
Ukulimala kwemithambo yegazi ngesikhathi se-PCI kubangela inqubo eyinkimbinkimbi yokuvuvukala nokulungiswa esikhathini esifushane (amasonto kuya ezinyangeni), okuholela ekukhuleni kwe-endothelialization kanye nokumbozwa kwe-neointimal. Ngokusho kokubonwa kwe-histopathological, i-neointimal hyperplasia (i-HMS ne-DES) ngemuva kokufakelwa kwe-stent kwakuqukethe ikakhulukazi amaseli emisipha ebushelelezi e-proliferative ku-proteoglycan-rich extracellular matrix. 70
Ngakho-ke, i-neointimal hyperplasia inqubo yokulungisa ehilela izici zokuqina nokuvuvukala, kanye namaseli abangela ukwanda kwamaseli emisipha ebushelelezi kanye nokwakheka kwe-extracellular matrix. Ngokushesha ngemva kwe-PCI, ama-platelet kanye ne-fibrin kufakwa odongeni lwemithambo yegazi futhi kudonsele ama-leukocyte ngochungechunge lwama-molecule okunamathela kwamaseli. Ama-leukocyte ajikelezayo anamathela kuma-platelet anamathiselwe ngokusebenzisana phakathi kwe-leukocyte integrin Mac-1 (CD11b/CD18) kanye ne-platelet glycoprotein Ibα 53 noma i-fibrinogen ehlotshaniswa ne-platelet glycoprotein IIb/IIIa. 76.77
Ngokusho kwedatha entsha, amangqamuzana okuqala omongo ahilelekile ekuphenduleni kwemithambo yegazi kanye nezinqubo zokulungisa. Ukunyakaza kwe-EPC kusuka kumongo kuya egazini elingaphandle kukhuthaza ukuvuselelwa kwe-endothelial kanye nokuvuselelwa kwemithambo yegazi ngemva kokubeletha. Kubonakala sengathi amangqamuzana okuqala omongo abushelelezi emisipha (ama-SMPC) aya endaweni yokulimala kwemithambo yegazi, okuholela ekwandeni kwemithambo yegazi. 78 Ngaphambilini, amangqamuzana ane-CD34 ayebhekwa njengeqembu eliqinile lama-EPC, izifundo ezengeziwe zibonise ukuthi i-antigen ye-CD34 surface iyawabona ngempela amangqamuzana okuqala omongo angenawo umehluko anekhono lokuhlukanisa abe ama-EPC nama-PBMC. Ukuguqulwa kwamaseli ane-CD34 abe uhlu lwe-EPC noma lwe-SMPC kuncike endaweni yasendaweni; izimo ze-ischemic zibangela ukwahlukana kuya ku-phenotype ye-EPC, okukhuthaza ukuvuselelwa kabusha, kuyilapho izimo zokuvuvukala zibangela ukwahlukana kuya ku-phenotype ye-SMPC, okukhuthaza ukwanda kwemithambo yegazi. 79
Isifo sikashukela sandisa ingozi ye-ISR ngo-30-50% ngemva kokufakelwa kwe-BMS, futhi izinga eliphezulu le-restenosis kubantu abanesifo sikashukela uma kuqhathaniswa neziguli ezingesona isifo sikashukela nalo laqhubeka enkathini ye-DES. Izindlela ezisekela lokhu kuqaphela cishe ziyizinto eziningi, okuhlanganisa isimiso somzimba (isb., ukuguquguquka kwempendulo yokuvuvukala) kanye nokwakheka komzimba (isb., imithambo emincane, izilonda ezinde, isifo esisabalalayo, njll.), okwandisa ngokuzimela ingozi ye-ISR. 70
Ububanzi bomkhumbi kanye nobude besilonda kuthinte amazinga e-ISR ngokuzimela, kanti ububanzi obuncane/izilonda ezinde kwandisa kakhulu amazinga okuphumula uma kuqhathaniswa nobubanzi obukhulu/izilonda ezimfushane.
Amapulatifomu e-stent esizukulwane sokuqala abonise ama-strut amakhulu kanye nama-ISR aphezulu uma kuqhathaniswa namapulatifomu e-stent esizukulwane sesibili ane-struts ezincane.
Ngaphezu kwalokho, ukwanda kwe-restenosis kuhlotshaniswa nobude be-stent, cishe kuphindwe kabili ngobude be-stent >35 mm uma kuqhathaniswa nalabo abangaphansi kwama-20 mm. Ngaphezu kwalokho, ukwenzeka kwe-restenosis kuhlotshaniswa nobude be-stent, cishe kuphindwe kabili ngobude be-stent obungu->35 mm uma kuqhathaniswa nalabo abangaphansi kuka-20 mm. Кроме того, частота рестеноза связана с длиной стента, почти удваиваясь при длине стента >35 мм по сравнению с длиной стента <20 мм. Ngaphezu kwalokho, izinga lokuphumula lihlobene nobude be-stent, cishe liphindwe kabili ngobude be-stent >35 mm uma kuqhathaniswa nobude be-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. Ngaphezu kwalokho, ukuvama kwe-restenosis kwakuncike kubude be-stent: ubude be-stent >35 mm bucishe buphindwe kabili kunobe-stent <20 mm.Ububanzi bokugcina be-lumen obuncane be-stent nabo budlale indima ebalulekile: ububanzi obuncane be-lumen obuncane bokugcina bubikezela ingozi ekhulayo kakhulu ye-restenosis. 81.82
Ngokwesiko, i-intimal hyperplasia ngemva kokufakelwa kwe-BMS ibhekwa njengezinzile, kanye nenani eliphakeme ekuqaleni phakathi kwezinyanga eziyi-6 nonyaka owodwa kulandelwa isikhathi sokulala sekwephuzile. Inani eliphakeme ekuqaleni kokukhula kwe-intimal kulandelwa ukuhlehla kwe-intimal ngokukhuliswa kwe-lumen eminyakeni eminingana ngemva kokufakelwa kwe-stent liye labikwa ngaphambilini; ukuvuthwa kwamaseli emisipha ebushelelezi kanye nezinguquko ku-extracellular matrix kuye kwaphakanyiswa njengezindlela ezingenzeka zokuhlehla kwe-neointima sekwephuzile. 83 Kodwa-ke, izifundo zokulandelela zesikhathi eside zibonise impendulo ye-triphasic ngemva kokubekwa kwe-BMS nge-restenosis yasekuqaleni, ukuhlehla okuphakathi, kanye ne-late luminal restenosis. 84
Esikhathini se-DES, ukukhula kwe-neointimal sekwephuzile kwaqala ukubonakala ngemva kokufakelwa kwe-SES noma i-PES kumamodeli ezilwane. 85 Izifundo eziningana ze-IVUS zibonise ukuncishiswa kokuqala kokukhula kwe-intimal kulandelwa ukubamba sekwephuzile ngokuhamba kwesikhathi ngemva kokufakelwa kwe-SES noma i-RPE, mhlawumbe ngenxa yenqubo yokuvuvukala eqhubekayo.86
Naphezu "kokuzinza" okuvame ukubhekwa njenge-ISR, cishe ingxenye yesithathu yeziguli ezine-BMS ISR ziba ne-ACS.
Kukhona ubufakazi obandayo bokuthi ukuvuvukala okungapheli kanye/noma ukungasebenzi kahle kwe-endothelial kubangela i-neoatherosclerosis eqhubekayo ku-HCM kanye ne-DES (ikakhulukazi i-DES yesizukulwane sokuqala), okungaba yindlela ebalulekile yokuthuthukiswa kwe-IR eqhubekayo noma i-ST eqhubekayo. U-Inoue et al [87] babike okutholakele kwe-histological autopsy ngemuva kokufakwa kwama-stents e-coronary e-Palmaz-Schatz, okuphakamisa ukuthi ukuvuvukala okuzungeze i-stent kungabangela izinguquko ezintsha ze-atherosclerotic ngaphakathi kwe-stent. Ezinye izifundo10 zibonise ukuthi izicubu ze-restenotic ngaphakathi kwe-CGM yeminyaka emi-5 ziqukethe i-atherosclerosis esanda kuqala enokuvuvukala kwe-peritoneal noma engenakho; amasampula avela emacaleni e-ACS abonisa ama-plaque ajwayelekile asengozini emithanjeni ye-coronary yemvelo I-Histological block morphology ene-foamy macrophages namakristalu e-cholesterol. Ngaphezu kwalokho, lapho kuqhathaniswa i-BMS ne-DES, kwaphawulwa umehluko omkhulu ngesikhathi sokuthuthukiswa kwe-atherosclerosis entsha. 11,12 Izinguquko zokuqala ze-atherosclerotic ekungeneni kwe-foamy macrophage zaqala ezinyangeni ezi-4 ngemuva kokufakelwa kwe-SES, kanti izinguquko ezifanayo ezilonda ze-CGM zenzeka ngemva kweminyaka emi-2 futhi zahlala ziyimbangela engavamile kuze kube yiminyaka emi-4. Ngaphezu kwalokho, i-DES stenting yezilonda ezingazinzile njenge-thin tegmental fibroatherosclerosis (TCFA) noma i-intimal rupture inesikhathi esifushane sokuthuthuka uma kuqhathaniswa ne-BMS. Ngakho-ke, i-neoatherosclerosis ibonakala ivame kakhulu futhi yenzeka ekuqaleni kwe-DES yesizukulwane sokuqala kune-BMS, mhlawumbe ngenxa ye-pathogenesis ehlukile.
Umthelela wesizukulwane sesibili i-DES noma i-DES ekuthuthukisweni usazohlolwa; yize okunye okubonwe kakade kwesizukulwane sesibili i-DES88 kuphakamisa ukuvuvukala okuncane, ukwanda kwe-neoatherosclerosis kuyafana uma kuqhathaniswa nesizukulwane sokuqala, kodwa kusadingeka izifundo ezengeziwe.