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一种用于治疗冠状动脉疾病的新型铂铬依维莫司洗脱支架。

A novel platinum chromium everolimus-eluting stent for the treatment of coronary artery disease.

作者信息

Bennett Johan, Dubois Christophe

机构信息

Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.

出版信息

Biologics. 2013;7:149-59. doi: 10.2147/BTT.S34939. Epub 2013 Jun 19.

Abstract

The development of coronary stents represents a major step forward in the treatment of obstructive coronary artery disease since the introduction of percutaneous coronary intervention. The initial enthusiasm for bare metal stents was, however, tempered by a significant incidence of in-stent restenosis, the manifestation of excessive neointima hyperplasia within the stented vessel segment, ultimately leading to target vessel revascularization. Later, drug-eluting stents, with controlled local release of antiproliferative agents, consistently reduced this need for repeat revascularization. In turn, the long-term safety of first-generation drug-eluting stents was brought into question with the observation of an increased incidence of late stent thrombosis, often presenting as myocardial infarction or sudden death. Since then, new drugs, polymers, and platforms for drug elution have been developed to improve stent safety and preserve efficacy. Development of a novel platinum chromium alloy with high radial strength and high radiopacity has enabled the design of a new, thin-strut, flexible, and highly trackable stent platform, while simultaneously improving stent visibility. Significant advances in polymer coating, serving as a drug carrier on the stent surface, and in antiproliferative agent technology have further improved the safety and clinical performance of newer-generation drug-eluting stents. This review will provide an overview of the novel platinum chromium everolimus-eluting stents that are currently available. The clinical data from major clinical trials with these devices will be summarized and put into perspective.

摘要

自经皮冠状动脉介入治疗引入以来,冠状动脉支架的发展是阻塞性冠状动脉疾病治疗中的一大进步。然而,裸金属支架最初的热情因支架内再狭窄的高发生率而有所降温,支架内再狭窄是指支架置入血管段内过度的新生内膜增生,最终导致靶血管再血管化。后来,药物洗脱支架通过控制抗增殖药物的局部释放,持续减少了重复再血管化的需求。反过来,第一代药物洗脱支架的长期安全性受到质疑,因为观察到晚期支架血栓形成的发生率增加,常表现为心肌梗死或猝死。从那时起,人们开发了新的药物、聚合物和药物洗脱平台,以提高支架安全性并保持疗效。一种具有高径向强度和高射线不透性的新型铂铬合金的开发,使得设计出一种新的、薄支柱、灵活且高度可跟踪的支架平台成为可能,同时提高了支架的可视性。作为支架表面药物载体的聚合物涂层以及抗增殖药物技术的重大进展,进一步提高了新一代药物洗脱支架的安全性和临床性能。本综述将概述目前可用的新型铂铬依维莫司洗脱支架。将总结这些器械主要临床试验的临床数据并进行分析。

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