CVPath Institute, Gaithersburg, MD, USA.
School of Medicine, University of Maryland, Baltimore, MD, USA.
Nat Rev Cardiol. 2020 Jan;17(1):37-51. doi: 10.1038/s41569-019-0234-x. Epub 2019 Jul 25.
Implantation of drug-eluting stents (DES) is the dominant treatment strategy for patients with symptomatic coronary artery disease. However, the first-generation DES had substantial drawbacks, including delayed healing, local hypersensitivity reactions and neoatherosclerosis, which all led to a steady increase in major adverse cardiovascular events over time. Subsequently, newer-generation DES were introduced with thinner struts, different scaffold designs (to improve deliverability while maintaining radial strength), different durable and biodegradable polymers - and in some cases no polymer (to improve vascular biocompatibility) - and new antiproliferative drug types and doses. Currently, >30 different DES are commercially available in Europe, with fewer available in the USA but with many new entrants coming onto the US market in the next few years. Never before have cardiologists been faced with so many choices of stent, each with its own unique design. In this Review, we detail preclinical and pathology studies for each stent design, examining thromboresistance, speed of neointimal coverage and completeness of healing, including endothelialization. We conclude by discussing how these design characteristics might affect the potential for shortening the minimum duration of dual antiplatelet therapy needed after coronary intervention.
药物洗脱支架（DES）的植入是治疗有症状的冠状动脉疾病患者的主要治疗策略。然而，第一代 DES 存在许多缺陷，包括延迟愈合、局部过敏反应和新动脉粥样硬化，所有这些都导致随着时间的推移，主要不良心血管事件的发生率稳步上升。随后，推出了新一代 DES，其具有更薄的支柱、不同的支架设计（在保持径向强度的同时提高可输送性）、不同的耐用和可生物降解聚合物——在某些情况下则没有聚合物（以提高血管生物相容性）——以及新的抗增殖药物类型和剂量。目前，欧洲有 >30 种不同的 DES 可供商业使用，美国的则较少，但在未来几年内，许多新的 DES 将进入美国市场。心脏病专家以前从未面临过如此多的支架选择，每个支架都有其独特的设计。在这篇综述中，我们详细介绍了每种支架设计的临床前和病理学研究，研究内容包括血栓抵抗性、新生内膜覆盖和愈合的速度和完整性，包括内皮化。最后，我们讨论了这些设计特点如何影响缩短冠状动脉介入治疗后双联抗血小板治疗所需最短持续时间的潜力。
