远端保护装置在AMI患者急诊PCI中的应用价值课件.ppt

药物支架的评价与新进展 首都医科大学附属北京安贞医院 刘宇扬 周玉杰 Evolution of stent material BiodivYsio: poly [phosphorylcholine-lauryl methacrylate]Taxus: poly [styrene-isobutyl-styrene] Cypher: poly-n-butyl methacrylate + polyethylene-vinyl acetate Potential risk produced by polymers Biodegradable Polymers CoStar Bioresorbable Polymer Summary EPCs-capturing stent GENOUS stent1 year result of 2 studies 321 pts with ASTEMI undergoing primary PCI 3 cases of stent thrombosis (0.9%), 42 cases of MACE (13.1%), 24 deaths (7.5%), 12 recurrent MI (3.7%), and 16 TVR (5%) at 1year  Stent fracture  Stent fractureappearance in IVUS 2-yrs Results from ABSORB Trialpresent at TCT 2008 The universe of futuristic DES Stent platform: More flexible, thin, radial strength Drug: less toxic, lower doses, combination therapy (antiproliferative + pro-healing + thrombo-resistant) Polymer: biocompatible, or bioabsorbable materials, and stent surface modification technique Bioabsorbable stent: safer long-term solution(?) Promising carriers in future Adverse outcome of stent fracture Stent fracture appears to be a clinically relevant predisposing factor to ISR Factors that possibly predispose to stent fracture include: Overlapping stents Stent design Vessel angulations and cardiac motion High-magnification SME image of BiodivYsio, Taxus and Cypher stents after expansion in air. (a–b) The inner surface of a BiodivYsio stent shows excess polymer on the stent edges as well as peeling. (c) Inner surface of a Taxus stent shows polymer peeling with stent metal exposure, and (d) regions of polymer bridging across strut loops, linear cracking associated with bridges. (e) The inner surface of a Cypher stent shows peeling of the top coat with expansion-induced cracking and (f) major peeling of the polymer. 支架退送机扩张，容易造成polymer剥脱碎裂，造成药物释放不均匀、在局部形成血栓，容易在狭窄， 可降解polymer不是解决目前这种致栓特性唯一的的途径，一些公司研发虽然不降解polymer,但生物相容型号的polymer,例如：xience,氟聚合物,spirit1~3系列试验 * * * Bolloom-BMS-DES-BIO-GENE（WUCHUANG） 支架平台和推送系