Bridges Jonathan, Cutlip Donald
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Med Devices (Auckl). 2009;2:1-8. Epub 2008 Dec 7.
Coronary artery disease remains one of the leading causes of death in the United States. Over the last 30 years, the development of coronary artery angioplasty and stenting has drastically reduced mortality during acute coronary syndromes while also reducing symptoms of chronic coronary artery disease. Unfortunately, the placement of stents in a coronary artery can be complicated by in-stent thrombosis or restenosis. In 2003-2004, a new generation of stents was introduced to the market with the goal of reducing the rate of restenosis. These stents, called drug eluting stents (DES), are coated with a pharmacological agent designed to reduce the neointimal hyperplasia associated with restenosis. Within a year, approximately 80% of all percutaneous coronary interventions performed within the US involved placement of a DES. In 2006, a controversy arose about the possibility of a statistically significant increased risk of acute stent thrombosis associated with DES especially when used for an "off label" indication. This risk was attributed to delayed endothelization. This controversy has led to a reduction in the use of DES along with longer use of dual platelet inhibition with aspirin and clopidogrel. Recently Medtronic introduced a new DES to the market called the Endeavor(®) stent - a zotarolimus eluting stent.
冠状动脉疾病仍然是美国主要的死因之一。在过去30年中，冠状动脉血管成形术和支架置入术的发展极大地降低了急性冠状动脉综合征期间的死亡率，同时也减轻了慢性冠状动脉疾病的症状。不幸的是，在冠状动脉中置入支架可能会因支架内血栓形成或再狭窄而变得复杂。在2003年至2004年期间，新一代支架被推向市场，目的是降低再狭窄率。这些支架被称为药物洗脱支架（DES），表面涂有一种药理剂，旨在减少与再狭窄相关的新生内膜增生。在一年内，美国境内约80%的经皮冠状动脉介入治疗涉及DES的置入。2006年，出现了一场争议，即与DES相关的急性支架血栓形成风险在统计学上是否显著增加，尤其是在用于“非标签”适应症时。这种风险被归因于内皮化延迟。这场争议导致DES的使用减少，同时阿司匹林和氯吡格雷双重抗血小板抑制的使用时间延长。最近，美敦力公司向市场推出了一种名为安珂（®）支架的新型DES——一种佐他莫司洗脱支架。
