Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
Cardiovasc Interv Ther. 2021 Jan;36(1):23-29. doi: 10.1007/s12928-020-00734-7. Epub 2020 Nov 21.
Drug-eluting stents (DES) were developed to overcome in-stent restenosis (ISR), which has long been considered the main complication limiting the long-term efficacy of coronary stenting. New-generation DES which composed of advanced stent design with and without specific biocompatible polymer contributes a reduction of the incidence of ISR to rate ranging from 5 to 10%. The precise reasons of DES restenosis are still controversial and not fully understood. Angiographic and coronary images at the index procedure, systemic status of patients, medications, and intracoronary imaging at ISR site are all considered to find the possible mechanisms of DES restenosis. Multiple biological, genetic, mechanical, and technical factors might intricately contribute to DES restenosis. Biological and genetic factors of ISR are not able to be sufficiently modified by the current medical approaches. Tailored treatments avoiding mechanical and technical factors of ISR are required to reduce DES restenosis. Elucidation of DES restenosis leads to further improvement in the current DES system and finds the optimal approach to treat DES restenosis. The possible mechanisms of DES restenosis are discussed in this review.
药物洗脱支架（DES）的开发是为了克服支架内再狭窄（ISR），ISR 长期以来一直被认为是限制冠状动脉支架长期疗效的主要并发症。新一代 DES 由先进的支架设计组成，无论是否使用特定的生物相容性聚合物，都有助于将 ISR 的发生率降低到 5%至 10%。DES 再狭窄的确切原因仍存在争议，尚未完全了解。在索引程序中进行血管造影和冠状动脉成像、患者的全身状况、药物治疗以及 ISR 部位的腔内影像学检查，都是为了寻找 DES 再狭窄的可能机制。多种生物学、遗传学、机械学和技术因素可能错综复杂地导致 DES 再狭窄。目前的医疗方法无法充分改变 ISR 的生物学和遗传学因素。需要针对机械和技术因素制定针对性的治疗方法，以减少 DES 再狭窄。阐明 DES 再狭窄有助于进一步改进当前的 DES 系统，并找到治疗 DES 再狭窄的最佳方法。本文讨论了 DES 再狭窄的可能机制。
