Schofer Joachim, Bode Christoph, Silber Sigmund
Center for Cardiology and Vascular Intervention, Hamburg, Germany.
Herz. 2004 Mar;29(2):195-200. doi: 10.1007/s00059-004-2570-8.
In-stent restenosis (ISR) remains the "Achilles' heel" of percutaneous stent angioplasty treatment of patients with atherosclerotic disease of the coronary arteries. Recently, drug-eluting stents (DES) have ushered in a revolution in the treatment of these patients, yet, to date, their efficacy and safety have been demonstrated primarily for native de novo coronary lesions. For ISR, intracoronary brachytherapy using beta- or gamma-radiation is considered the standard of care. Nevertheless, DES are used for ISR lesions in clinical practice. This review outlines the few results currently available from small observational studies and larger registries. The designs of two ongoing randomized trials evaluating the sirolimus-eluting and the paclitaxel-eluting stent versus brachytherapy in patients with ISR lesions are also presented. Patients with acute myocardial infarction (AMI) have mostly been investigated in the context of small, uncontrolled studies and registries. The incomplete evidence to date is that implantation of sirolimus-eluting stents in patients with AMI is safe and effective.
支架内再狭窄（ISR）仍然是经皮冠状动脉支架血管成形术治疗冠状动脉粥样硬化疾病患者的“阿喀琉斯之踵”。最近，药物洗脱支架（DES）给这些患者的治疗带来了一场革命，然而，迄今为止，其疗效和安全性主要是在原发性冠状动脉病变中得到证实。对于支架内再狭窄，使用β射线或γ射线的冠状动脉内近距离放射治疗被认为是标准治疗方法。尽管如此，药物洗脱支架在临床实践中仍用于治疗支架内再狭窄病变。本综述概述了目前从小型观察性研究和大型注册研究中获得的少量结果。还介绍了两项正在进行的随机试验的设计，这些试验旨在评估西罗莫司洗脱支架和紫杉醇洗脱支架与近距离放射治疗在支架内再狭窄病变患者中的疗效。急性心肌梗死（AMI）患者大多是在小型、非对照研究和注册研究中进行调查的。目前不完整的证据表明，在急性心肌梗死患者中植入西罗莫司洗脱支架是安全有效的。
