Herrman J P, Hermans W R, Vos J, Serruys P W
Catheterization Laboratory, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Drugs. 1993 Jul;46(1):18-52. doi: 10.2165/00003495-199346010-00003.
Luminal renarrowing after balloon angioplasty still hampers the long term vessel patency in a substantial percentage of patients. Morphologically, the restenotic lesion comprises hyperplasia of intimal tissue, which is mainly characterised by proliferation of smooth muscle cells of the synthetic type with abundant extracellular matrix production, chiefly composed of proteoglycans. Unravelling the underlying pathophysiological process enables more specific intervention in basic interactions and cell responses. Critical events in the development of restenotic tissue are platelet aggregation and thrombus formation, while the release of several mediators promotes proliferation and migration of various cell types. All of these steps give access for a diversity of pharmacological interventions. With this in mind, antithrombotic, antiplatelet, antiproliferative, antiinflammatory, calcium channel blocking and lipid-lowering drugs have been investigated in the prevention of restenosis. Part II of this article reviews newer approaches, such as antibodies to growth factors, gene transfer and antisense oligonucleotides.
球囊血管成形术后管腔再狭窄仍然在相当比例的患者中妨碍长期血管通畅。从形态学上看，再狭窄病变包括内膜组织增生，其主要特征是合成型平滑肌细胞增殖并产生丰富的细胞外基质，主要由蛋白聚糖组成。阐明潜在的病理生理过程能够对基本相互作用和细胞反应进行更具针对性的干预。再狭窄组织形成过程中的关键事件是血小板聚集和血栓形成，而几种介质的释放促进了各种细胞类型的增殖和迁移。所有这些步骤都为多种药物干预提供了途径。考虑到这一点，人们已经研究了抗血栓、抗血小板、抗增殖、抗炎、钙通道阻滞和降脂药物在预防再狭窄方面的作用。本文第二部分综述了更新的方法，如生长因子抗体、基因转移和反义寡核苷酸。
