Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20100 Milan Italy.
Curr Pharm Des. 2010;16(36):4052-63. doi: 10.2174/138161210794454851.
Stent thrombosis (ST) is a rare complication following coronary stenting; however given the associated serious consequences, in particular death and myocardial infarction, it remains a source of considerable concern for cardiologists. Although no differences have been found between drug-eluting stents (DES) and bare-metal stents (BMS) in terms of early ST, some studies have reported adverse outcomes associated with DES as compared to BMS at long-term follow-up. Delayed endothelial coverage of the stent struts, inflammation and local hypersensitivity due to the interaction between the drug and polymer coating have been characterized to be typical for DES compared to BMS and may prolong the window of vulnerability to ST. Consequently the recommended duration of dual antiplatelet therapy (DAT) was longer with DES than with BMS. Results from studies investigating the optimal duration of DAT remain inconclusive and the current recommendation seems to be that patients undergoing DES implantation should have DAT for at least 6-12 months. Our treatment strategy requires more detailed analysis and should improve as we understand more about the impact of the newer generation DES and variability in antiplatelet therapy response, in addition to the effects of novel therapeutic agents and the availability of more data on the optimum duration of DAT.
支架血栓形成（ST）是冠状动脉支架置入术后罕见的并发症；然而，鉴于其相关的严重后果，特别是死亡和心肌梗死，它仍然是心脏病专家关注的一个重要问题。虽然在早期 ST 方面，药物洗脱支架（DES）和裸金属支架（BMS）之间没有发现差异，但一些研究报告称，与 BMS 相比，DES 在长期随访中存在不良结局。与 BMS 相比，DES 中支架支柱的内皮覆盖延迟、炎症和药物与聚合物涂层相互作用引起的局部过敏反应是典型的，这可能会延长 ST 的易损期。因此，DES 的双联抗血小板治疗（DAT）推荐持续时间长于 BMS。研究 DAT 最佳持续时间的结果仍不一致，目前的建议似乎是，接受 DES 植入的患者应接受 DAT 至少 6-12 个月。我们的治疗策略需要更详细的分析，并且随着我们对新一代 DES 的影响以及抗血小板治疗反应的可变性的了解，以及新型治疗药物的作用和更多关于 DAT 最佳持续时间的数据的可用性，我们的治疗策略应该会得到改善。
