Coronary Restenosis

冠狀動脈血管再狹窄

張釗監(Chao-Chien Chang) ； 王榮添(Eng-Thiam Ong)

《Acta Cardiologica Sinica》 21卷4期 (2005/12) Pp. 177-189

摘要

冠狀動脈疾病的介入性療法中，血管支架置放術比傳統的氣球擴張術有較令人滿意的結果，已有多篇的文獻證實。隨著使用率的增加，血管支架置放後所遭遇的難題，如血管再狹窄，是心臟科醫師所要面臨的一大問題。血管再狹窄的問題，尤其在有糖尿病或者multivessel的冠狀動脈疾病患者最為嚴重，往往限制血管成型術的好處。最近，美國食品和藥品管理局(FDA)批准brachytherapy和drug-eluting stents作為在stent的再狹窄問題上之可行的治療選擇。本篇文章將探討血管再狹窄問題的病理生理學和分子機轉，並回顧當今與將來的治療選擇。

關鍵字

冠狀動脈血管再狹窄 ； 血管再狹窄問題的病理生理學和分子機轉

並列摘要

Percutaneous coronary interventions represent an attractive alternative to surgical revascularization; nevertheless, these techniques continue to be characterized by their propensity to elicit restenosis. Until now, the only widely accepted way to reduce restenosis rate has been the stent. However, clinical restenosis still represents the major limitation of this technology. Despite this limitation, angioplasty has become the most common revascularization procedure for coronary artery disease. Although the advent of coronary stents has reduced the incidence of restenosis, the problem still occurs in 20% to 30% of stented vessels. Restenosis is the principal drawback of percutaneous coronary interventions. Furthermore, the numerous drugs and mechanical interventions that have been used to address restenosis have had minimal success. Restenosis severely limits the benefits of angioplasty in many patients, particularly those with diabetes or multivessel coronary artery disease. Despite an exhaustive search for an effective pharmacotherapy to treat or prevent restenosis, hundreds of clinical trials have failed to identify an agent with proven therapeutic benefit. Recently, however, the Food and Drug Administration approved intracoronary radiation (brachytherapy) and drug-eluting stents as viable therapeutic options for in-stent restenosis. In addition, recent randomized trials have shown encouraging results with drug-eluting stents. This article reviews the pathophysiology and molecular mechanism of restenosis, along with current and future treatment options.

並列關鍵字

Coronary restenosis ； Pathophysiology and molecular mechanism of restenosis