金属裸支架在药物洗脱支架时代的作用_乔树宾.ppt
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1、金属裸支架 在药物洗脱支架时代的作用,阜外心血管病医院 乔树宾 2009-5-16,毫无疑问,药物支架在降低再狭窄率方面是被广泛临床实践所验证的。 但也存在值得关注的问题!,注:公布于2006年美国ACC大会,Stone,GW,et al. 该文章荟萃分析了个雷帕霉素的随机对比研究和个紫杉醇的对比研究,随访四年表明:与裸支架相比,药物涂层支架总的血栓发生率并没有明显增加,但是植入药物涂层支架一年后血栓发生率增加。,Days,0,60,120,180,300,360,420,480,540,Events Rate,0.00,0.02,0.04,0.06,0.08,0.10,0.12,0.14,0
2、.16,Patients without Plavix,Patients on Plavix,Cumulative incidence of ST = 58/3021 pts (1.9%),ST within 6 mo 1.4%,ST after 6 mo 0.5%,240,Source: Chieffo, TCT 06.,Milan Study Shows Patients on Plavix having LST,Chieffo & Colombo: Showed 9 of the 16 LST patients were on Plavix Patients without Plavix
3、 had increased thrombosis in first 6 months Emphasized Plavix is needed for 1st six months,不稳定 心绞痛,血栓,糖尿病,无保护 左主干,分叉病变,肾功衰,既往血管腔内放射治疗,抗小板治疗过早终止,支架血栓发生率 (%),“过早中断持久的抗血小板治疗的患者有29%发生支架血栓,坚持药物的抗血小板治疗极为重要 .” Iakovou et al,Overall stent thrombosis = 1.3% (P=0.09, N=2229),累计支架血栓单变量预测因素 (9个月) 对 TAXUS 支架和 Cy
4、pherTM 支架的分析,成功植入药物释放支架后支架血栓的发生率,预测因素,和结果 Iakovou et al., JAMA. 2005;293:2126-2130,Iakovou et al. JAMA. 2005;293:2126.,CypherTM is a registered trademark of Cordis Corporation,TAXUS Stents are contraindicated in patients with lesions involving a bifurcation, unprotected left main and presence of def
5、inite or propable intraluminal thrombus.,Daemon J et al. Lancet 2007; 369:667-78,LAD:,LCX:,OM:,AMI急诊并大量血栓,Vision 3.5*18,BMS Implanted in Big Vessels,No. 1 2005, Vessel=2.8 mm,No. 4, Mar 2007, Vessel=3.5 mm,No. 5, Aug 2007, Vessel=3.5 mm,No. 6, Jun 2007, Vessel=4 mm,No. 7, Aug 2008 Vessel=3.0,No. 3,
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- 金属 支架 药物 洗脱 时代 作用 乔树宾
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