Scott Neal A
Camino Cardiovascular Associates, 525 South Drive, Suite 107, Mountain View, CA 94040, USA.
Adv Drug Deliv Rev. 2006 Jun 3;58(3):358-76. doi: 10.1016/j.addr.2006.01.015. Epub 2006 Mar 6.
This review summarizes the restenotic process that occurs after the implantation of bare metal coronary stents. The pathology of in-stent restenosis is distinct from that seen after balloon angioplasty and is characterized by neointimal proliferation and extracellular matrix deposition. The degree of neointimal proliferation is proportional to the amount of injury, the intensity of the inflammatory infiltrate and the association of stent struts with lipid-filled plaque. In-stent restenosis also appears to be associated with systemic markers of inflammation. Shear stress has an important influence on restenosis as does the presence and adhesiveness of vascular progenitor cells. Clinical predictors (e.g., artery size, stent length, diabetes, and gender) may affect the incidence of restenosis seen after stent placement. A number of catheter-based interventions have been used to treat in-stent restenosis. Although preliminary data suggest that the use of drug-eluting stents may be effective, only intracoronary radiation has shown consistent efficacy in randomized trials.
本综述总结了裸金属冠状动脉支架植入后发生的再狭窄过程。支架内再狭窄的病理学与球囊血管成形术后所见不同，其特征为内膜增生和细胞外基质沉积。内膜增生程度与损伤量、炎症浸润强度以及支架支柱与脂质填充斑块的关联成正比。支架内再狭窄似乎也与全身炎症标志物有关。剪切应力以及血管祖细胞的存在和黏附性对再狭窄有重要影响。临床预测因素（如动脉大小、支架长度、糖尿病和性别）可能会影响支架置入后再狭窄的发生率。已采用多种基于导管的干预措施来治疗支架内再狭窄。尽管初步数据表明使用药物洗脱支架可能有效，但在随机试验中只有冠状动脉内放射治疗显示出一致的疗效。
