Moriyama Noriaki, Shishido Koki, Tanaka Yutaka, Laine Mika, Saito Shigeru
Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan.
Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland.
Circ Rep. 2019 Nov 16;1(12):543-549. doi: 10.1253/circrep.CR-19-0100.
Although metallic stents improved the safety and efficacy of percutaneous coronary intervention (PCI), even the latest generation of drug-eluting stents (DES) is still limited by several factors. The limitations of DES are mainly related to the permanent metallic caging in vessel, chronic inflammatory response to the polymer and adverse effects of antiproliferative drug on endothelial tissue, leading to impaired physiological vasomotor response and late stent-related adverse events such as stent thrombosis and neoatherosclerosis. Bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular) was designed to overcome these drawbacks of DES by disappearing from the vessel wall. Absorb BVS, however, was withdrawn from the world market because of increased incidence of scaffold thrombosis compared with DES. Importantly, only very limited long-term post-BVS implantation data are available, especially with regard to neoatherosclerosis, which can lead to very late adverse events even after resorption of the scaffold. Therefore, the goal of this review was to highlight the mid to long term clinical outcomes published to date, and to describe the features of the intimal healing process and neoatherosclerosis in the 5 years following Absorb BVS implantation, mainly based on our previous study. This may provide important information on the pathophysiology of the scaffolded vessel for clinicians, and promote identification of future bioresorbable materials for PCI that will minimize the stimulus for neoatherosclerosis.
尽管金属支架提高了经皮冠状动脉介入治疗（PCI）的安全性和有效性，但即使是最新一代的药物洗脱支架（DES）仍受到多种因素的限制。DES的局限性主要与血管内永久性金属支架、对聚合物的慢性炎症反应以及抗增殖药物对内皮组织的不良反应有关，导致生理血管舒缩反应受损以及晚期支架相关不良事件，如支架血栓形成和新生动脉粥样硬化。生物可吸收血管支架（Absorb BVS；雅培血管）旨在通过从血管壁消失来克服DES的这些缺点。然而，由于与DES相比支架血栓形成发生率增加，Absorb BVS已退出全球市场。重要的是，关于BVS植入后的长期数据非常有限，尤其是关于新生动脉粥样硬化的数据，即使在支架吸收后也可能导致非常晚期的不良事件。因此，本综述的目的是突出迄今为止发表的中长期临床结果，并主要基于我们之前的研究描述Absorb BVS植入后5年内内膜愈合过程和新生动脉粥样硬化的特征。这可能为临床医生提供有关支架血管病理生理学的重要信息，并促进识别未来用于PCI的生物可吸收材料，从而将新生动脉粥样硬化的刺激降至最低。
