摘要
冠心病介入治疗已经成为冠心病的重要治疗方法。但是支架内再狭窄是冠心病介入医师不得不面对的一个问题。近年来随着关于ISR发生的病理生理学基础研究细胞信号转导等基础研究的深入,有关各种针对其发生机制的相关防治方法不断发展。各种涂层支架、冠脉内放射治疗、基因治疗以及口服药物治疗为解决ISR提供了各种方法。本文就冠脉支架术后支架内再狭窄的发生机制及诊治进展进行了综述。
The long term outcome of stent implantation is affected by a process called in-stent restenosis （ISR）. In-stent restenosis remains a problem that is the chest pain after coronary stent placement. Multiple contributory factors have been identified, but clear understanding of the overall underlying mechanism remains an enigma. ISR progresses through several different phases involve numerous cellular and molecular constituents. Platelets and macrophages play key role in vascular smooth muscle cell migration and proliferation in the intima to produce neointimal hyperplasia. Increased extracellular matrix formation appears to form the bulk of the neointimal hyperplasia tissue. Emerging evidence of the role of inflammatory cytokines and suppressors of cytokine signalling make this an exciting and novel field of antirestenosis research. Activation of Akt pathway triggered by mechanical stretch may also be a contributory factor to ISR formation, In this review, we provide an overview of therapeutic options .Intracoronary brachytherapy using beta or gamma radiation had been considered the standard of care for some years. However, the use of drug eluting stents （DES） to treat ISR had been shown to be safe, effective and ease-of-use for the prevention of recurrent restenosis. These beneficial effects had been demonstrated mainly with Cypher （Cordis Corporation） and Taxus （Boston Scientific ） stents. ISR after DES when focal angiographic pattern was present can be often treated with balloon angioplasty whereas if a non-focal pattern was recognized a new DES implantation was indicated. Waiting for a definitive answer regarding the optimal treatment oflSR from ongoing trials, we presented our current approach to ISR.
出处
《现代生物医学进展》
CAS
2008年第7期1346-1349,共4页
Progress in Modern Biomedicine
基金
新疆自治区高校科研计划创新群体(XJEDU2005G03)
关键词
冠心病
介入治疗
再狭窄
Coronary artery disease, Percutaneous coronary interventions, In-stent restenosis
