股腘动脉支架置入术的过去、现在与未来

Past, present and future of femoropopliteal stenting.

作者信息

Schillinger Martin, Minar Erich

机构信息

Department of Angiology, Medical University Vienna, Austria.

出版信息

J Endovasc Ther. 2009 Feb;16 Suppl 1:I147-52. doi: 10.1583/1545-1550-16.16.I-147.

Abstract

Endovascular stent implantation was introduced to femoropopliteal procedures almost 2 decades ago. Initial results with balloon-expandable stainless steel stents and self-expanding Elgiloy stents, however, were disappointing. In particular, recurrence rates after long-segment femoropopliteal stenting were catastrophically high, in the range of 60% to 80% at 1 year. Also, attempts to resolve the problem of in-stent restenosis (ISR) using first-generation covered stent-grafts led to unsatisfactory results, high procedural complication rates due to large introducers, and a high incidence of graft thrombosis, which did not make these devices convincing alternatives to bare metal stents. After years of stagnation, however, recent developments in femoropopliteal stent technology have been promising. Self-expanding nitinol stents have been evaluated in several prospective studies. Initial problems with stent fractures seem to be resolved using second-generation devices; for the first time, stenting has been shown to be beneficial compared to balloon angioplasty in longer femoropopliteal lesions. Nevertheless, although superior to balloon angioplasty, nitinol stenting is still associated with a considerable restenosis rate, and treatment of ISR remains problematic. Future concepts to further improve long-term patency after femoropopliteal stenting therefore are under investigation, including drug-eluting stents, biodegradable stents, and coated stent-grafts. From a current perspective, femoropopliteal stenting remains the Achilles' heel of the interventionist.

摘要

血管内支架植入术于近20年前被引入股腘动脉手术。然而,最初使用球囊扩张式不锈钢支架和自膨胀式埃尔吉洛伊合金支架的结果令人失望。特别是,长段股腘动脉支架置入术后的复发率高得惊人,1年时在60%至80%的范围内。此外,使用第一代覆膜支架型血管移植物解决支架内再狭窄(ISR)问题的尝试导致了不尽人意的结果,由于导入器较大导致手术并发症发生率高,以及移植物血栓形成的发生率高,这使得这些装置无法成为裸金属支架令人信服的替代方案。然而,经过多年的停滞,股腘动脉支架技术最近的发展很有前景。自膨胀镍钛诺支架已在多项前瞻性研究中得到评估。使用第二代装置似乎解决了支架断裂的最初问题;首次表明,在较长的股腘动脉病变中,支架置入术比球囊血管成形术更有益。尽管如此,尽管镍钛诺支架置入术优于球囊血管成形术,但仍与相当高的再狭窄率相关,ISR的治疗仍然存在问题。因此,正在研究进一步提高股腘动脉支架置入术后长期通畅率的未来概念,包括药物洗脱支架、可生物降解支架和覆膜支架型血管移植物。从目前的角度来看,股腘动脉支架置入术仍然是介入治疗的致命弱点。

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