Radak Djordje, Djukic Nenad, Tanaskovic Slobodan, Obradovic Milan, Cenic-Milosevic Desanka, Isenovic Esma R
Dedinje Cardiovascular Institute, School of Medicine, University of Belgrade, Belgrade, Serbia.
Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, Serbia.
Curr Vasc Pharmacol. 2017;15(3):230-237. doi: 10.2174/1570161115666170105121900.
Endovascular surgery represents a minimally invasive procedure for the treatment of occlusive and aneurysmal arterial disease. However, it is followed by inflammatory response, with a rise in specific inflammatory biomarkers, such as C-reactive protein, serum amyloid A and fibrinogen. Shear stress during balloon inflation and vascular injury represents triggering events for the inflammatory process, stimulating the production of proinflammatory molecules and activation of circulating monocytes. The current literature indicates that stent implantation induces more prominent inflammatory reaction. Additionally, it has been shown that muscular arteries of femoropopliteal segment react to a greater extent to stent implantation, compared with elastic carotid or iliac arteries. The endovascular treatment of thoracic and abdominal aortic aneurysm is frequently followed with post-implantation inflammatory syndrome. Most recent findings point out that stent graft material plays a significant role in the inflammatory response, representing a challenge for clinicians. Future studies should consider the pathophysiology of the inflammatory response associated with endovascular procedures as well as predictors and risk factors including preventive strategies and therapeutic algorithms. Although the potential role of anti-inflammatory drugs after endovascular procedures has been observed, it needs to be validated in upcoming trials. The Neutrophil Lymphocyte Ratio, platelet count, Platelet-to-Lymphocyte Ratio and other biomarkers should be considered in future trials to assess the inflammatory response after endovascular procedures. Inflammatory markers may also become therapeutic targets.
血管内手术是治疗闭塞性和动脉瘤性动脉疾病的一种微创手术。然而，术后会出现炎症反应，特定的炎症生物标志物如C反应蛋白、血清淀粉样蛋白A和纤维蛋白原会升高。球囊扩张和血管损伤时的剪切应力是炎症过程的触发事件，刺激促炎分子的产生和循环单核细胞的激活。目前的文献表明，支架植入会引发更显著的炎症反应。此外，已有研究表明，与弹性的颈动脉或髂动脉相比，股腘段的肌性动脉对支架植入的反应更大。胸主动脉瘤和腹主动脉瘤的血管内治疗术后常伴有植入后炎症综合征。最新研究结果指出，支架移植物材料在炎症反应中起重要作用，这对临床医生来说是一项挑战。未来的研究应考虑与血管内手术相关的炎症反应的病理生理学，以及包括预防策略和治疗算法在内的预测因素和危险因素。尽管已观察到血管内手术后使用抗炎药物的潜在作用，但仍需在后续试验中进行验证。在未来的试验中应考虑中性粒细胞与淋巴细胞比值、血小板计数、血小板与淋巴细胞比值及其他生物标志物，以评估血管内手术后的炎症反应。炎症标志物也可能成为治疗靶点。
