Fassa Amir-Ali, Urban Philip
Cardiology Department, Bichat Hospital, AP-HP, Paris, France.
Adv Cardiol. 2012;47:114-24. doi: 10.1159/000338054. Epub 2012 Aug 9.
Coronary stents are used during the majority of percutaneous coronary interventions. When compared to medical therapy, they have been shown to decrease mortality for patients with acute coronary syndromes, and to improve symptom control in patients with stable angina. Their use, however, may be complicated by stent thrombosis (ST), a potentially fatal event. Early ST, which occurs during the first month following device implantation, is usually linked to procedural factors, with similar frequencies for bare metal stents and drug-eluting stents (DES). Late and very late (between 1 month and 1 year, respectively, and >1 year after the procedure) ST, which appear to be more frequent with DES, are due to factors such as incomplete stent apposition, delayed or dysfunctional endothelialization, and chronic inflammation. Furthermore, discontinuation of antiplatelet therapy (which includes the association of aspirin and thienopyridines) or resistance to these molecules may also lead to ST. New stent designs as well as the use of more potent antiplatelet therapies should contribute to reducing the incidence of ST in the future.
在大多数经皮冠状动脉介入治疗中都会使用冠状动脉支架。与药物治疗相比，冠状动脉支架已被证明可降低急性冠状动脉综合征患者的死亡率，并改善稳定型心绞痛患者的症状控制。然而，其使用可能会并发支架内血栓形成（ST），这是一种潜在的致命事件。早期ST发生在装置植入后的第一个月内，通常与手术因素有关，裸金属支架和药物洗脱支架（DES）的发生频率相似。晚期和极晚期ST（分别发生在术后1个月至1年之间以及术后1年以上）在DES中似乎更常见，其原因包括支架贴壁不全、内皮化延迟或功能障碍以及慢性炎症。此外，停用抗血小板治疗（包括阿司匹林和噻吩吡啶联合使用）或对这些药物产生耐药性也可能导致ST。新的支架设计以及使用更强效的抗血小板治疗方法应有助于在未来降低ST的发生率。
