Joviliano Edwaldo Edner, Piccinato Carlos Eli, Dellalibera-Joviliano Renata, Moriya Takachi, Évora Paulo R B
Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Ann Vasc Surg. 2011 Aug;25(6):846-55. doi: 10.1016/j.avsg.2011.02.026. Epub 2011 May 28.
In this article, we review the current status of inflammation linked to percutaneous transluminal angioplasty with stent implantation, especially as it relates to restenosis and its clinical implications. Common to multiple vascular diseases, including atherosclerosis, interventional restenosis is a localized inflammatory reaction. Activated smooth muscle cells respond to local inflammation and migrate from the media into the lumen of the vessel, where they proliferate and synthesize cytokines which they respond to in an autocrine manner, sustaining the progression of the lesion. The deleterious effects of proinflammatory cytokines, particularly immunomodulatory interleukins, on vascular pathophysiology and development of these maladaptive processes have been the subject of intense study. Matrix metalloproteinases and tissue inhibitors of metalloproteinases are important in many physiologic and pathologic processes and their expression is related with the classic cardiovascular risk factors as well as with inflammation. They seem to play a central role in atherosclerosis and restenosis. The primary use of drug-eluting stents has become routine clinical practice for coronary artery disease, but the use in peripheral arteries remains to be further studied, like that demonstrated in sirolimus-coated Cordis trials. New studies to understand this complex process in peripheral arteries are warranted.
在本文中，我们回顾了与经皮腔内血管成形术及支架植入相关的炎症的现状，尤其是其与再狭窄的关系及其临床意义。包括动脉粥样硬化在内的多种血管疾病共有的特点是，介入性再狭窄是一种局部炎症反应。活化的平滑肌细胞对局部炎症作出反应，并从血管中层迁移至血管腔内，在那里它们增殖并合成细胞因子，这些细胞因子以自分泌方式对其作出反应，维持病变的进展。促炎细胞因子，特别是免疫调节性白细胞介素，对血管病理生理学和这些适应不良过程发展的有害影响一直是深入研究的课题。基质金属蛋白酶和金属蛋白酶组织抑制剂在许多生理和病理过程中都很重要，它们的表达与经典心血管危险因素以及炎症有关。它们似乎在动脉粥样硬化和再狭窄中起核心作用。药物洗脱支架的主要用途已成为冠状动脉疾病的常规临床实践，但在外周动脉中的应用仍有待进一步研究，如西罗莫司涂层Cordis试验所示。有必要开展新的研究来了解外周动脉中的这一复杂过程。
