Schwartz R S
Mayo Medical School, Rochester, MN 55905, USA.
Semin Interv Cardiol. 1997 Jun;2(2):83-8.
Coronary angioplasty imposes injury on the coronary artery during the procedure to achieve adequate revascularization. The arterial response to that injury is critical to both the acute and long-term success or failure of the procedure. As newer technologies become clinically available, it is increasingly evident that a final common response to angioplasty is neointimal formation, and adventitial contraction known as remodelling. Both procedures appear to occur to varying degrees, and similarly appear dependent on the degree of injury. Neointimal hyperplasia is a major factor in the restenosis problem, although others are clearly important. Additional factors include thrombus, intimal and medial dissections and elastic recoil of the arterial wall. The proportion of the restenosis problem caused by each is unclear, but current efforts to solve restenosis centre on limiting neointimal hyperplasia, the primary response to injury of the vessel. This paper will review arterial injury during revascularization in both patients and animal models, with special emphasis of the nature and formation of neointimal hyperplasia.
冠状动脉血管成形术在手术过程中会对冠状动脉造成损伤，以实现充分的血管再通。动脉对这种损伤的反应对于该手术的急性和长期成败至关重要。随着更新的技术在临床上可用，越来越明显的是，血管成形术的最终共同反应是内膜增生和称为重塑的外膜收缩。这两种过程似乎都在不同程度上发生，并且同样似乎取决于损伤程度。内膜增生是再狭窄问题的主要因素，尽管其他因素显然也很重要。其他因素包括血栓、内膜和中膜夹层以及动脉壁的弹性回缩。每种因素导致再狭窄问题的比例尚不清楚，但目前解决再狭窄的努力集中在限制内膜增生上，这是血管对损伤的主要反应。本文将回顾患者和动物模型在血管再通过程中的动脉损伤，特别强调内膜增生的性质和形成。
