可降解支架治疗下肢动脉疾病的研究进展
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1.中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 血管外科 心血管疾病国家重点实验室,北京 100037;2.中南大学湘雅二医院 血管外科, 湖南 长沙 410011

作者简介:

曹忠泽,中国医学科学院阜外医院硕士研究生,主要从事血管外科微创治疗方面的研究。

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湖南省长沙市科技局“揭榜挂帅”重大科技计划基金资 助项目(kq2102003);湖南省长沙市科技局科技重大专项基金资助项目(kh2102014)。


Progress in bioresorbable stents for the treatment of lower extremity artery disease
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1.State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China;2.Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, China

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    摘要:

    下肢动脉疾病(LEAD)指因动脉粥样硬化斑块形成导致的下肢动脉狭窄或闭塞。据估算,全世界25岁以上人群中约有2.37亿例罹患LEAD,我国的LEAD患者约有4 530万例,疾病负担重。腔内血运重建为缓解保守治疗效果不佳的LEAD患者下肢缺血症状的首选治疗方式。但是,受限于内膜增生等支架植入后反应,腔内血运重建术后的中远期初级通畅率仍逊于开放手术,且再干预率更高。作为血管腔内永久性金属支架植入的新型替代治疗方案,可降解支架(BRS)指由聚合物或金属材料制成的,可在体内被逐步分解、吸收并降解,降解产物可被完全排出人体的支架。BRS植入后可为狭窄段血管提供临时管壁支撑,理想状态下可在血管重塑后完全降解,恢复生理性血管反应性和内皮功能。有望避免支架内再狭窄等远期并发症,进一步提升LEAD腔内血运重建疗效。目前,REMEDY、ABSORB、AMS等BRS已被用于LEAD治疗。其中,REMEDY支架治疗下肢动脉闭塞性病变的疗效欠佳,其治疗狭窄性病变的效果与内膜切除和镍钛合金支架植入相比并无明显优势。ABSORB治疗膝下动脉病变的术后1年通畅率高,靶病变再干预率较低。与经皮球囊血管成形术相比,AMS支架植入后6个月的初级通畅率显著更低,无法达到有效性评价指标。此外,目前尚无高质量循证医学证据说明LEAD患者BRS植入后应如何开展抗血栓治疗。未来,应开发具备更佳材料性能、更优结构设计的新一代BRS,并将其与各类LEAD腔内治疗方式结合,有效提升LEAD医疗质量。

    Abstract:

    Lower extremity arterial disease (LEAD) refers to the stenosis or occlusion of lower limb arteries caused by atherosclerotic plaque formation. It is estimated that approximately 237 million people worldwide, aged 25 and above, suffer from LEAD. In China, there are around 45.3 million LEAD patients, imposing a significant disease burden. Endovascular revascularization is the preferred treatment method for alleviating lower limb ischemic symptoms in LEAD patients with poor response to conservative therapy. However, due to reactions such as intimal hyperplasia after stent implantation, the mid- to long-term primary patency rates of endovascular revascularization remain inferior to open surgery, with a higher rate of reintervention. As a novel alternative treatment for the permanent metallic stent implantation, bioresorbable stents (BRS) are stents made from polymers or metal materials that can gradually decompose, degrade and eventually be completely eliminated from the body. After BRS implantation, temporary wall support is provided to the narrowed vascular segment, ideally degrading completely after vascular remodeling to restore physiological vasomotor activity and endothelial function. BRS holds the potential to avoid long-term complications such as in-stent restenosis, thereby further improving the efficacy of endovascular revascularization for LEAD. Currently, BRS such as REMEDY, ABSORB, and AMS have been used in the treatment of LEAD. REMEDY stent treatment for occlusive lesions of lower limb arteries shows suboptimal efficacy, with no apparent advantage over endarterectomy and nitinol stent implantation in treating stenotic lesions. ABSORB demonstrates a high 1-year patency rate for infrapopliteal lesions and a lower rate of target lesion reintervention. In comparison to percutaneous balloon angioplasty, AMS stent implantation has a significantly lower primary patency rate at six months and fails to meet efficacy evaluation criteria. Moreover, there is currently no high-quality recommendations of evidence-based medicine to guide anti-thrombotic treatment after BRS implantation in LEAD patients. In the future, efforts should be directed towards developing the next generation of BRS with superior material properties and optimal structural design. These advancements should be integrated with various endovascular treatment modalities for LEAD to effectively improve the quality of medical care for LEAD patients.

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曹忠泽,舒畅.可降解支架治疗下肢动脉疾病的研究进展[J].中国普通外科杂志,2023,32(12):1952-1958.
DOI:10.7659/j. issn.1005-6947.2023.12.015

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  • 收稿日期:2023-09-27
  • 最后修改日期:2023-12-05
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  • 在线发布日期: 2024-01-09