Kereiakes Dean J, Onuma Yoshinobu, Serruys Patrick W, Stone Gregg W
From The Christ Hospital, Heart and Vascular Center, Lindner Research Center, Cincinnati, OH (D.J.K.); Thorax Centre, Erasmus MC, Rotterdam, The Netherlands (Y.O.); International Centre for Cardiovascular Health, Imperial College, London, UK (P.W.S.); and New York Presbyterian Hospital, Columbia University Medical Center, and the Cardiovascular Research Foundation, New York (G.W.S.).
Circulation. 2016 Jul 12;134(2):168-82. doi: 10.1161/CIRCULATIONAHA.116.021539.
Contemporary metallic drug-eluting stents are associated with very good 1-year outcomes but an ongoing risk of stent-related adverse events (thrombosis, myocardial infarction, restenosis) after 1 year. The pathogenesis of these very late events is likely related to the permanent presence of the metal stent frame or polymer. Bioresorbable scaffolds have been developed to provide drug delivery and mechanical support functions similar to metallic drug-eluting stents, followed by complete resorption with recovery of more normal vascular structure and function, potentially improving very late clinical outcomes. A first-generation bioresorbable scaffold has been demonstrated to be noninferior to a contemporary metallic drug-eluting stents for overall 1-year patient-oriented and device-oriented outcomes. Increased rates of scaffold thrombosis and target vessel-related myocardial infarction were noted that may be mitigated by improved patient and lesion selection, procedural technique, and device iteration. Large-scale, randomized, clinical trials are ongoing to determine the long-term relative efficacy and safety of bioresorbable scaffolds compared with current metallic drug-eluting stents.
当代金属药物洗脱支架具有非常好的1年疗效，但在1年后仍存在与支架相关的不良事件（血栓形成、心肌梗死、再狭窄）的持续风险。这些极晚期事件的发病机制可能与金属支架框架或聚合物的长期存在有关。已开发出生物可吸收支架，以提供与金属药物洗脱支架类似的药物递送和机械支撑功能，随后完全吸收，使血管结构和功能恢复得更正常，有可能改善极晚期临床疗效。第一代生物可吸收支架已被证明在以患者为导向和以器械为导向的总体1年疗效方面不劣于当代金属药物洗脱支架。注意到支架血栓形成和靶血管相关心肌梗死的发生率增加，这可能通过改善患者和病变选择、手术技术以及器械迭代来缓解。正在进行大规模随机临床试验，以确定生物可吸收支架与当前金属药物洗脱支架相比的长期相对疗效和安全性。
