聚合物-365心血管网.ppt

PCI新进展？ 冠脉支架 无聚合物DES 可吸收DES（BVS） 介入技术 TAVI 二尖瓣钳夹术 左心耳封堵 辅助药物 抗血小板 抗凝 临床研究 介入模式？ 为什么会有进展？ 临床问题导向 (clinical problem oriented) 只要临床上问题存在，就需技术进展 临床未解问题之需 (unmet clinical needs) 只要临床问题还未解决，就应有进展 发现临床问题： 是介入进展的原冲动 解决临床问题： 是介入进展的原动力 What’s the problems of DES ? Safety problems LST and VLST Stent Malapposition, intimal uncoverage Late catch-up（in restenosis） Hypersensitivity and inflammation What causes the problems ? What left after drug eluting ? Permanent polymer BMS 和 DES的区别？ 刚植入时： DES：多了：药+聚合物涂层(polymer) 药物释放后： DES: 多了：聚合物涂层 Advantages of polymer free DES Nothing left except of BMS No polymer No LST VLST No stent late malapposition No intimal uncoverage No inflammation No hypersensitivity No late catch-up No safety problems Polymer free DES Yukon ( Germany ) Spray Yinyi polymer free PES ( Yinyi, Da lian ) Nano polymer free SES ( Partner, Beijing ) 模拟血管模型(SAM)中的输送性 闭合状态下模架的柔软度 径向强度的变化 – BVS Cohort B 节杆覆盖率: ABSORB 6个月OCT结果 机械导控 机械导控 物质的吸收:从聚乳酸降解到乳酸代谢 猪冠状动脉安全性研究:组织学图片 (2x) Conclusion (PCI 主要进展 ) 新支架的进展最为突出 为解决DES的LST和VLST安全问题而设计 主要 以国产的无聚合物DES为代表 乐普Nano支架 银艺微孔支架 冠脉理想支架：生物可吸收，恢复血管生理功能 Bioresorbable vascular scarfold ( BVS )( Abott Vascular) Long-term safety problems Restore physiological vasomotion 我国正在做临床试验（高院长 PI） 预计两年年内会获批临床应用 谢 谢！ 粗糙支架表面有利于内皮修复，同样能降低再狭窄率和管腔丢失 A length 0.34mm, B length 0.11mm * In order to develop an optimal bioabsorbable DES, and to better our chances for success, we are leveraging technologies we have experience with – technologies that have proven themselves as some of the best technologies in the industry. The delivery catheter we are using is from the Vision stent system. This catheter is recognized as having a high of deliverability. The stent platform has evolved from technology developed by researchers at Duke University over 20 years ago. He stent is made from poly lactic acid, or PLA, a material that is absorbed by natural processes in the body. The coating is also made from PLA. The polymer i