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JACC:钴铬合金依维莫司洗脱支架可降低支架内再血栓发生率

2013-12-06 佚名 丁香园

目前FDA批准的生物可吸收支架 研究要点: 1.既往研究指出,第一代药物涂层支架虽可减少支架内再狭窄及再血管化的风险,但随之引起的支架内再次血栓成为临床使用的一大问题。 2.钴铬合金依维莫司洗脱支架是第二代药物涂层支架的一种,通过在支架结构及设计上进行了提高,并使用了生物可相容及生物可吸收性多聚物,与其他药物涂层支架支架相比,可降低支架内再血栓的发

目前FDA批准的生物可吸收支架

研究要点:

1.既往研究指出,第一代药物涂层支架虽可减少支架内再狭窄及再血管化的风险,但随之引起的支架内再次血栓成为临床使用的一大问题。

2.钴铬合金依维莫司洗脱支架是第二代药物涂层支架的一种,通过在支架结构及设计上进行了提高,并使用了生物可相容及生物可吸收性多聚物,与其他药物涂层支架支架相比,可降低支架内再血栓的发生率,提高了临床使用的可行性及安全性。

3.目前,更多的具有生物可吸收、可充吸收特性的药物涂层支架正进入更大规模的临床研究中。

既往研究指出,第一代药物涂层支架通过支架表面涂层聚合物,缓慢释放西罗莫司或者紫杉醇,较金属支架相比可明显减少支架内再狭窄及再血管化的风险。然而,随着临床的广泛应用,研究发现,第一代药物涂层支架可能导致血管延迟愈合及多聚物超敏反应,进而造成慢性炎症,并导致晚期或晚晚期支架内血栓的发生。也由于这一副作用,患者需要长期双联抗血小板治疗。基于此,意大利Palmerini T等人针对药物涂层支架引起支架内再血栓的临床研究进展进行了综述,综述在线发表于2013年11月19日的J Am Coll Cardiol杂志上。

针对第一代药物涂层支架发生支架内再血栓概率增高这一并发症,第二代药物涂层支架在支架结构及设计上进行了提高,并使用了生物可相容及生物可吸收性多聚物,可减少支架内再血栓的发生。许多meta分析指出,钴铬合金依维莫司洗脱支架与其他药物涂层支架支架相比,可降低支架内再血栓的发生率。在一些研究中,其支架内再血栓的发生率甚至低于金属裸支架。

文章指出,钴铬合金依维莫司洗脱支架使用细杆结构以及有抗栓特性的含氟聚合物,并通过减少多聚物成分及药物负荷,可降低支架内再血栓的发生,效果甚至优于金属裸支架。这一结果使我们不得不对药物涂层支架在支架内再血栓方面进行重新考虑。钴铬合金依维莫司洗脱支架通过使用生物可吸收、可相容的含氟聚合物作为其载体,提高了临床使用的可行性及安全性。

这篇综述指出,第二代药物涂层支架如钴铬合金依维莫司洗脱支架,在支架结构及设计上进行了提高,并使用了生物可相容及生物可吸收性多聚物,与其他药物涂层支架支架相比,可降低支架内再血栓的发生率,具有临床使用的可行性及安全性。

研究背景:

2006年,欧洲心脏病大会上首次提出,第一代药物涂层支架与金属裸支架相比虽可显著减少再支架内血管化的发生,但可能增加晚期支架内血栓的发生,这一问题随即引起公众关注。

出于这一安全因素的考虑,第二代药物涂层支架使用不同的药物,并使用具有生物可吸收可相容的支架载体,以期减少支架内再血栓的发生。目前FDA批准上市的第二代药物涂层支架包括钴铬合金依维莫司洗脱支架Xience V、Xience Prime,、及Xience Expedition (Abbott Vascular, Santa Clara, California), 铂铬合金依维莫司洗脱支架Promus Element (Boston Scientifi c, Natick, Massachusetts), 磷脂酰胆碱涂层佐他莫司洗脱支架Endeavor (Medtronic, Santa Rosa, California), 以及佐他莫司洗脱支架Resolute (Medtronic)。与第一代药物涂层支架相比,第二代药物涂层支架,提高了临床使用的可行性及安全性,是冠心病患者支架植入治疗的一大进展。

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    2014-01-15 hbwxf
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    2013-12-08 楚秀娟

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