Serruys P W, Strauss B H, van Beusekom H M, van der Giessen W J
Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1991 May;17(6 Suppl B):143B-154B. doi: 10.1016/0735-1097(91)90951-5.
Interventional cardiology has recently witnessed the growth of several alternatives to percutaneous transluminal angioplasty, including coronary stenting. Although stenting appears to be useful in treating abrupt closure after coronary angioplasty, its effectiveness in limiting the complex processes responsible for late restenosis is much less certain. Pathologic examination of stented human saphenous bypass grafts shows extensive deposits of platelets, fibrin and leukocytes along the stent wires within the 1st week and formation of a neointima of variable thickness after 3 months without evidence of foreign body reaction. The long-term effects of continuous barotrauma induced by the expanded stent remain unknown. It is difficult to assess the relative merits of the new devices, but stenting has several theoretic advantages. It seems less disruptive to the underlying architecture of the vessel wall and enjoys favorable theoretic and effective expansion ratios. Wide-spread clinical acceptance for stenting will depend on demonstrating that its safety, efficacy and cost efficiency are superior to those of balloon angioplasty.
近年来，介入心脏病学领域出现了几种经皮腔内血管成形术的替代方法，包括冠状动脉支架置入术。尽管支架置入术似乎有助于治疗冠状动脉成形术后的急性血管闭塞，但其在限制导致晚期再狭窄的复杂过程方面的有效性却不太确定。对置入支架的人体大隐静脉旁路移植血管进行病理检查发现，在第1周内，沿支架丝有大量血小板、纤维蛋白和白细胞沉积，3个月后形成厚度不一的新生内膜，且无异物反应迹象。扩张后的支架持续造成的气压伤的长期影响尚不清楚。很难评估这些新装置的相对优点，但支架置入术有几个理论上的优势。它似乎对血管壁的基础结构破坏较小，并且具有良好的理论和有效扩张率。支架置入术能否得到广泛的临床认可，将取决于能否证明其安全性、有效性和成本效益优于球囊血管成形术。
