Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Munich, Germany.
New York Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA; The Cardiovascular Research Foundation, New York, NY, USA.
Lancet. 2017 Aug 19;390(10096):781-792. doi: 10.1016/S0140-6736(17)31927-X.
Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies. Balloon angioplasty was limited by unpredictable procedural outcomes due to vessel dissection and recoil, and a high rate of restenosis. The introduction of stents resulted in more stable early results and lower rates of restenosis, although early stent thrombosis and neointimal hyperplasia causing vessel renarrowing were key limitations. Drug-eluting stents delivering antiproliferative agents significantly lowered the rates of restenosis, permitting widespread use of percutaneous coronary intervention in more advanced and complex disease. Although fully bioresorbable scaffolds have the potential to further improve long-term outcomes, they have not yet achieved results equivalent to those of conventional metallic drug-eluting stents in the early years after implantation. Progress in catheter technology did not occur in isolation, and the success of percutaneous coronary intervention is also due to important advances in intracoronary imaging, and adjunct pharmacotherapy-each of which is reviewed in other papers in this Series.
自 1977 年 9 月 16 日首例冠状动脉成形术以来，经皮冠状动脉介入治疗领域发展迅速。如今，经皮冠状动脉介入治疗迎来了 40 周年，已成为全球最常见的医疗程序之一。这一进展在很大程度上要归功于血管成形术技术的迭代和改进。球囊血管成形术由于血管夹层和回缩导致的不可预测的手术结果以及较高的再狭窄率而受到限制。支架的引入带来了更稳定的早期结果和更低的再狭窄率，尽管早期支架血栓形成和新生内膜增生导致血管再狭窄是主要的局限性。输送抗增殖药物的药物洗脱支架显著降低了再狭窄率，允许在更先进和复杂的疾病中广泛使用经皮冠状动脉介入治疗。虽然完全可生物吸收的支架有可能进一步改善长期结果，但在植入后的早期，它们尚未达到与传统金属药物洗脱支架相当的结果。导管技术的进步并非孤立发生，经皮冠状动脉介入治疗的成功还得益于冠状动脉内成像和辅助药物治疗的重要进展——本系列中的其他论文对此进行了综述。
