生物可吸收支架治疗冠状动脉分叉病变的临床进展  

Clinical Progress of Bioresorbable Stents for Treatment in Coronary Bifurcation Lesions

作　　者：奚倩兰 龚深圳 陈晓平[1,2] 

机构地区：[1]四川大学华西临床学院研究生院,四川成都610000 [2]四川大学华西医院心内科,四川成都610000

出　　处：《心血管病学进展》2018年第2期201-205,共5页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(81600299)

摘　　要：近年来,大量创新的治疗方式被不断引入心脏介入治疗中,相较于金属支架,植入血管后数年内可完全吸收的生物支架因促进内皮功能修复、血管重建及减少支架内晚期血栓形成等在治疗冠状动脉分叉病变中具有潜在的优势。现就生物可吸收支架(BRS)的生物学特性及在冠状动脉分叉病变治疗中的临床经验进行详细综述。BRS不推荐运用于分支血管近端直径<2.5 mm和近、远端主支血管内径差异>0.5 mm的冠状动脉分叉病变的治疗。双支架策略治疗真性冠状动脉分叉病变时,BRS+BRS是否较BRS+药物洗脱支架带来更高心血管获益目前证据有限,备受关注的COBRA研究有望对此进行阐述。同时,考虑到BRS较药物洗脱支架存在更高的分支闭塞及支架内血栓形成风险,更强效的抗血小板治疗可能增加心血管获益。Numerous advances and innovative therapies have been introduced in interventional cardiology over the recent years. In comparison to metal stents,bioresorbable stents（BRS） when implanted into blood vessels can be fully absorbed after several years and are associated with benefits including restoration of endothelial function, positive vessel remodeling, and reduced risk for very late （stent） thrombosis, and has potential advantages when treating coronary bifurcation lesions. This review summarizes the biophysical characteristics of BRS and its clinical progress in the treatment of coronary bifurcation lesions. BRS are not recommended in bifurcations with a 〈 2. 5 mm side branch and a 〉0.5 mm size discrepancy between the proximal and distal main branch. The current evidence for better outcomes of double-stenting strategy using BRS ＋ BRS or BRS ＋ DES has been limited, which COBRA may help describe. Considering that BRS implantation was associated with a higher incidence of side branch occlusion and stent thrombosis compared with everolimus-eluting metallic stents,more aggressive antiplatelet therapy might be beneficial.

关 键 词：经皮冠膝介入术 生物可吸收支架 冠状动脉分叉病变 

分 类 号：R541.4[医药卫生—心血管疾病] R815[医药卫生—内科学]