Department of Cardiology and Angiology, Evangelisches Bethesda-Johanniter-Klinikum, 47228 Duisburg, Germany.
Nat Rev Cardiol. 2010 Apr;7(4):194-203. doi: 10.1038/nrcardio.2010.14. Epub 2010 Mar 2.
Drug-eluting stents (DES) have revolutionized interventional cardiology. The first bare-metal stents successfully prevented abrupt artery closure and reduced the likelihood of clinical restenosis compared with balloon angioplasty. They were, however, limited by the frequent occurrence of restenosis owing to smooth muscle proliferation, and resultant neointimal hyperplasia and target lesion revascularization. By coating stents with drugs that target smooth muscle cell proliferation, it has been possible to considerably attenuate in-stent restenosis. This innovative technology still has shortcomings, however, and novel approaches are needed to improve the safety and efficacy of DES. The main components that determine the performance of a stent are the stent backbone, active drug, polymer and delivery system, and each of these factors need to be examined to optimize DES platforms. Improvements include the use of new coating technologies, bioabsorbable stents, non-drug-based stent coatings, and tailored lesion therapy. Efforts to develop this technology further will greatly enhance the outcome for patients with coronary artery disease.
药物洗脱支架 (DES) 彻底改变了介入心脏病学。第一代金属裸支架成功地预防了动脉突然闭塞，并降低了与球囊血管成形术相比发生临床再狭窄的可能性。然而，由于平滑肌增殖，导致新生内膜过度增生和靶病变血运重建，它们的应用受到了限制。通过用针对平滑肌细胞增殖的药物涂覆支架，已经可以显著减轻支架内再狭窄。然而，这种创新技术仍有不足之处，需要新的方法来提高 DES 的安全性和疗效。决定支架性能的主要因素是支架骨架、活性药物、聚合物和输送系统，需要对这些因素进行检查以优化 DES 平台。改进措施包括使用新的涂层技术、生物可吸收支架、非药物支架涂层和针对性病变治疗。进一步开发这项技术的努力将极大地提高冠心病患者的治疗效果。
