Abstract:
This review aimed to explore the therapeutic effect of bioabsorbable stents in the inferior genicular artery, from the emergence of absorbable bare metal stents to the latest technology in polymer and anti-proliferative eluting drugs mixed with coated bioresorbable vascular stents (BVSs). Currently, there are conflicting data regarding the safety and effectiveness of BVSs in infrapopliteal artery interventions, especially compared to the current generation of drug-eluting stents (DESs). This review will cover the existing data on BVSs in reconstructing the infrapopliteal arterial blood flow and active clinical trials for future iterations of BVSs. In terms of primary patency rate and target lesion revascularization rate, the available research on the effectiveness of BVSs in reconstructing the infrapopliteal arterial blood flow suggests that a BVS is compatible with current DESs within 3-12 months; long-term data have not yet been reported. The ABSORB BVS is the most studied BVS in cardiovascular disease (CAD). Initially, the ABSORB BVS showed promising results. Managing intricate regions in peripheral artery disorders, such as branching or lengthy lesions, continues to be a formidable undertaking. In contrast to the advanced narrowing of arteries seen in standard permanent stent procedures, bioabsorbable stents have the potential to promote the expansion and beneficial merging of blood channels in the latter stages. Furthermore, incorporating stents and re-establishing the endothelial function can diminish the probability of restenosis or thrombosis. Nevertheless, the extent to which bioabsorbable stents may simultaneously preserve arterial patency and guarantee their structural integrity remains uncertain. The powerful and intricate mechanical stresses exerted by the blood in the superficial femoral artery and popliteal artery can cause negative consequences on any implant inserted into the vessel, regardless of its composition, even metal. Furthermore, incorporating stents is advantageous for treating persistent occlusive lesions since it does not impact later treatments, including corrective bypass operations. Evidence is scarce about the use of bioabsorbable stents in treating infrapopliteal lesions. Utilizing bioabsorbable stents in minor infrapopliteal lesions can successfully maintain the patency of the blood vessel lumen, whereas balloon angioplasty cannot offer this benefit. The primary focus of testing these materials is determining whether bioabsorbable scaffolds can provide adequate radial force in highly calcified elongated lesions. Indeed, using \"-limus\" medication elution technology in conjunction with bioabsorbable stents has previously offered clinical benefits in treating the popliteal artery, as evidenced by limited trials.BVSs for peripheral arterial disease (PAD) show promise and have the potential to offer a less inflammatory and more vessel-friendly option compared to permanent metallic stents. However, current evidence does not yet allow for a universal recommendation for their use. Thus, ongoing, and future studies, such as those examining the newer generation of bioresorbable scaffolds (BRSs) with improved mechanical properties and resorption profiles, will be crucial in defining the role of BRSs in managing PAD.
摘要:
本综述旨在探讨生物可吸收支架在膝下动脉的治疗效果。从可吸收裸金属支架的出现到聚合物和抗增殖药物与涂层生物可吸收血管支架(BVS)混合的最新技术。目前,关于BVSs在膝下动脉介入治疗中的安全性和有效性的数据相互矛盾,特别是与当前一代的药物洗脱支架(DES)相比。这篇综述将涵盖BVS在重建膝下动脉血流方面的现有数据,以及为BVS的未来迭代进行积极的临床试验。在原发通畅率和靶病变血运重建率方面,关于BVSs重建膝下动脉血流的有效性的现有研究表明,BVS在3-12个月内与当前的DESs兼容;长期数据尚未报道。ABSORBBVS是心血管疾病(CAD)中研究最多的BVS。最初,ABSORBBVS显示出有希望的结果。管理外周动脉疾病的复杂区域,如分支或冗长的病变,仍然是一项艰巨的任务。与标准永久性支架手术中看到的动脉深度狭窄相反,生物可吸收支架具有促进后期血液通道扩张和有益合并的潜力。此外,置入支架和重建内皮功能可以降低再狭窄或血栓形成的可能性。然而,生物可吸收支架在多大程度上可以同时保持动脉通畅并保证其结构完整性仍不确定。血液在股浅动脉和pop动脉中施加的强大而复杂的机械应力会对插入血管的任何植入物造成负面影响。不管它的组成,甚至是金属.此外,合并支架有利于治疗持续性闭塞性病变,因为它不会影响后期治疗,包括纠正旁路操作。关于使用生物可吸收支架治疗膝下病变的证据很少。利用生物可吸收支架在轻微的膝下病变可以成功地保持血管腔的通畅,而球囊血管成形术不能提供这种益处。测试这些材料的主要重点是确定生物可吸收支架是否可以在高度钙化的细长病变中提供足够的径向力。的确,使用“-limus”药物洗脱技术与生物可吸收支架结合使用,以前在治疗the动脉方面提供了临床益处,有限的试验证明了这一点。与永久性金属支架相比,用于外周动脉疾病(PAD)的BVS显示出希望,并有可能提供更少炎症和更血管友好的选择。然而,目前的证据尚不允许对其使用提出普遍建议.因此,正在进行,和未来的研究,例如那些研究具有改进的机械性能和吸收概况的新一代生物可吸收支架(BRS)的人,对于定义BRS在管理PAD中的作用至关重要。