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1、药物支架:支架,药物，聚合物对血管造成长期影响的究竟是什么?,0,药物完全洗脱,对血管的影响,时间,1Joner M et al JACC 2006;48:193-202 2Finn A et al Circulation 2005;112:270-278,持久的聚合物 生物可吸收的聚合物,聚合物的发展,假说:聚合物炎症对于长期安全性和有效性的潜在影响,*持久涂层:有潜在的*可产生持续的炎症反应*愈合不良/血栓风险,两种第一代药物支架内血栓形成,图A to C:支架血栓伴支架贴壁不良图D to F:支架血栓伴支架贴壁不良，弥漫的炎症浸润(嗜酸细胞及淋巴细胞浸润),Nakazawa G et a
2、l EuroInterventon Suppl 2008;4:C7-C10,持久的聚合物 生物可吸收的聚合物,聚合物的发展,生物可降解/生物可吸收 指应用药物后,在数周至数年的时间内通过自然的生物活性降解为无害成分的物质,生物可降解聚合物的优势,100%的药物释放和聚合物降解 不用担心像传统永久性的聚合物载体可能会引起的 长期结构损坏和慢性炎症影响支架术后抗血小板药物治疗时间6个月,减少病人费用减少了亚急性血栓和血管瘤的发生率,提高患者的 生存机率(?),StentS-stent,DrugSirolimus(195376g/stent),PolymerAsymmetric Biodegrada
3、ble PLA,New Generation DESFocus on Reducing Late Adverse Events,ExcelTM stent:biodegradable polymer coated SES,fully disolved within 6 months,Two-year Follow-up of EXCEL First-In-Man Clinical Study:The Medistra Excel Drug-elutIng STent TRiAl(MEDISTRA),T.Santoso*,A.Wong+,T.H.Koh+*Div.of Cardiology,De
4、pt.of Internal Medicine,Univ.of Indonesia Medical School&the Medistra Hospital,Jakarta,Indonesia+National Heart Centre,Singapore,Follow-up(6 months)(contd)Late loss,mmIn-segment0.200.270.020.53 In-stent0.220.320.080.55Restenosis(50%)In-segment7/52(13.5%)3/42(7.1%)9/186(4.8%)2/19(10.5%)In-stent6/52(1
5、1.5%)2/42(4.8%)7/186(3.8%)2/19(10.5%),CYPHER TAXUS EXCEL BMS,QCA analysis at 6 months*,*Biomatrix=3&Endeavour=1 were not included in the analysis,Multi-Center Registry of Excel BiodegrAdable Polymer-Coated Drug EluTing StEnt,CREATE,Stent Thrombosis Through 2 years,0.73%,LEADERS-TAKING THE LEAD IN DE
6、S CLINICAL EXCELLENCE 12 MONTHS RESULTS,Limus Eluted From A Durable vs ERodable Stent Coating,P=0.86,%,P=0.15,P=0.35,P=0.95,P=0.25,P=0.42,SAFETY ENDPOINTS 12 MONTHS,EFFICACY ENDPOINTClinically-Indicated Target Lesion Revascularization,5.9%,5.3%,SUMMARY,DES with biodegradable polymer is safe and effective with:Very low rate of MACELow rate of restenosisNo or very low rate of LST with 6 months dual anti-platelet regiment Better recovery of endothelial function,
