Kounis Nicholas G, Hahalis George, Theoharides Theoharis C
Department of Medical Sciences, School of Health Sciences, Patras Highest Institute of Education and Technology, Queen Olgas Square, Patras, Greece.
J Interv Cardiol. 2007 Oct;20(5):314-23. doi: 10.1111/j.1540-8183.2007.00283.x.
The use of drug-eluting stents (DES) for the treatment of coronary stenosis has increased sharply and now accounts for more than 75% of all coronary stents utilized. However, concern has been increasing that DES could be associated with stent thrombosis, paradoxical coronary vasoconstriction, and hypersensitivity reactions. Components of currently used DES have been reported to induce, either separately or synergistically, hypersensitivity reactions and possibly lead to cardiac events. DES-activated intracoronary mast cells could release histamine, arachidonic acid metabolites, proteolytic enzymes, as well as a variety of cytokines, chemokines, and platelet-activating factor (PAF) leading to local inflammation and thrombosis. These events may be more common than suspected because it is hard to document them, unless they become systemic, in which case they manifest themselves as the "Kounis syndrome," characterized by the concurrence of acute coronary events with hypersensitivity reactions. Recognition of this problem may lead to better vigilance, as well as new DES with mast cell blocking molecules that may also be disease modifying.
药物洗脱支架（DES）用于治疗冠状动脉狭窄的情况急剧增加，目前占所有使用的冠状动脉支架的75%以上。然而，人们越来越担心DES可能与支架血栓形成、矛盾性冠状动脉血管收缩和过敏反应有关。据报道，目前使用的DES的成分单独或协同作用可诱发过敏反应，并可能导致心脏事件。DES激活的冠状动脉内肥大细胞可释放组胺、花生四烯酸代谢产物、蛋白水解酶以及多种细胞因子、趋化因子和血小板活化因子（PAF），导致局部炎症和血栓形成。这些事件可能比人们怀疑的更为常见，因为除非它们发展为全身性，否则很难记录下来，而全身性时它们表现为“库尼斯综合征”，其特征是急性冠状动脉事件与过敏反应同时发生。认识到这个问题可能会提高警惕，并研发出带有肥大细胞阻断分子的新型DES，这些分子也可能改善疾病状况。
