kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2019-8-3-72-84kpccz-608Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWБИОАБСОРБИРУЕМЫЕ ЭНДОПРОТЕЗЫ ДЛЯ ЭНДОВАСКУЛЯРНОГО ЛЕЧЕНИЯ БОЛЬНЫХ ХИБС: ПРОБЛЕМЫ И ПЕРСПЕКТИВЫBIOABSORBABLE SCAFFOLDS FOR PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH CORONARY ARTERY DISEASE: PROBLEMS AND FUTURE PERSPECTIVEShttps://orcid.org/0000-0003-0394-7868ВоробьеваЮ. С.VorobevaYu. S.

аспирант кафедры госпитальной хирургии с курсом детской хирургии факультета непрерывного медицинского образования медицинского института 

тел. +7 (909) 151-26-89

ул. Миклухо-Маклая, 6, Москва, 117198

MD, PhD student at the Department of Hospital and Pediatric Surgery, Medical Institute

+7 (909) 151-26-89

6, Miklukho-Maklaya St., Moscow, Russian Federation, 117198

jule4ek@list.ruhttps://orcid.org/0000-0002-5335-5062ШугушевЗ. Х.ShugushevZ. K.

доктор медицинских наук, заведующий кафедрой сердечно-сосудистой хирургии факультета непрерывного медицинского образования медицинского института 

ул. Миклухо-Маклая, 6, Москва, 117198

MD, PhD, Chairman of the Department of Cardiovascular Surgery, Medical Institute

6, Miklukho-Maklaya St., Moscow, Russian Federation, 117198

https://orcid.org/0000-0001-7998-3051ФайбушевичА. Г.FaibushevichA. G.

кандидат медицинских наук, доцент, заведующий кафедрой госпитальной хирургии с курсом детской хирургии факультета непрерывного медицинского образования медицинского института 

ул. Миклухо-Маклая, 6, Москва, 117198

MD, PhD, Associate Professor, Chairman of the Department of Hospital and Pediatric Surgery, Medical Institute

6, Miklukho-Maklaya St., Moscow, Russian Federation, 117198

https://orcid.org/0000-0003-1933-6842МаксимкинД. А.MaximkinD. A.

кандидат медицинских наук, доцент кафедры госпитальной хирургии с курсом детской хирургии факультета непрерывного медицинского образования медицинского института 

ул. Миклухо-Маклая, 6, Москва, 117198

MD, PhD, Associate Professor at the Department of Hospital and Pediatric Surgery, Medical Institute

6, Miklukho-Maklaya St., Moscow, Russian Federation, 117198

Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияRUDN UniversityRussian Federation201928092019837284Copyright © Воробьева Ю.С., Шугушев З.Х., Файбушевич А.Г., Максимкин Д.А., 20192019Воробьева Ю.С., Шугушев З.Х., Файбушевич А.Г., Максимкин Д.А.Vorobeva Y.S., Shugushev Z.K., Faibushevich A.G., Maximkin D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/608

Основные положения Использование биоабсорбируемых сосудистых эндопротезов для эндоваскулярного лечения больных хронической ишемической болезнью сердца, в том числе с сопутствующим сахарным диабетом 2-го типа и дистальным типом поражения коронарного русла, позволит повысить эффективность эндоваскулярного лечения и улучшить отдаленный прогноз таких пациентов. 

В статье представлен анализ современных исследований по эффективности и безопасности различных генераций стентов, используемых для лечения больных хронической ишемической болезнью сердца. Обобщены основные проблемы, возникающие в отдаленном периоде у пациентов после имплантации стентов с лекарственным покрытием, что позволило обосновать целесообразность применения в клинической практике новой генерации – биоабсорбируемых эндопротезов, которые являются основной составляющей сосудистой репаративной терапии. Показано, что применение биоабсорбируемых эндопротезов для эндоваскулярного лечения больных показывает сопоставимую эффективность в сравнении с традиционными стентами с лекарственным покрытием. Отдельное внимание уделено техническим особенностям имплантации биоабсорбируемых эндопротезов, использованию визуализирующих методов для контроля имплантации, а также срокам двойной антиагрегантной терапии в послеоперационном периоде. Освещены нерешенные вопросы использования первых генераций биоабсорбируемых эндопротезов, касающиеся окончательных сроков абсорбции, особенностей двойной антиагрегантной терапии, эффективности эндопротезов у больных сахарным диабетом 2-го типа, а также при стентировании дистальных сегментов коронарных артерий. Показаны перспективы сосудистой репаративной терапии, которые ассоциируются с использованием новых, усовершенствованных поколений биоабсорбируемых эндопротезов, позволяющих существенно повысить эффективность чрескожных коронарных вмешательств при использовании данных устройств.

 

Highlights. Bioabsorbable vascular scaffolds for percutaneous coronary interventions in multivessel coronaryartery disease patients and concomitant type 2 diabetes mellitus may increase the effectiveness of endovascular treatment and improve the long-term prognosis. 

The review article discusses recent data and evidences on the efficacy and safety of various stent generations for treating patients with coronary artery disease. The main complications commonly occurred following the implantation of drug-eluting stents in the long-term period are summarized, suggesting the rationale for the use of the next generation bioabsorbable vascular scaffolds in routine clinical practice. Bioabsorbable vascular scaffolds for endovascular treatment of patients with coronary artery disease show comparable efficacy compared with conventional drug-eluting stents. Particular attention is paid to the technical approaches of bioabsorbable vascular scaffold implantation, the use of intavascular imaging to control the implantation, as well as the timing of dual antiplatelet therapy in the postoperative period. The final term of the first-generation scaffold absorption, dual antiplatelet therapy, the effectiveness of bioabsorbable vascular scaffold-treated distal lesions and safety in patients with type 2 diabetes are highlighted. Future perspectives of using the next generation bioabsorbable vascular scaffolds that may improve the efficiency of percutaneous coronary interventions are presented.

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Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents: 2-Year Results of a Prospective, Multicenter Registry Study. JACC Cardiovasc Interv. 2017;10(16): 1607-1617. DOI: 10.1016/j.jcin.2017.05.059.Stuckey T.D., Kirtane A.J., Brodie B.R., Witzenbichler B., Litherland C., Weisz G., Rinaldi M.J., Neumann F.J., Metzger D.C., Henry T.D., Cox D.A., Duffy P.L., Mazzaferri E.L. Jr., Gurbel P.A., Mehran R., Généreux P., Ben-Yehuda O., Simonton C.A., Stone G.W. Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents: 2-Year Results of a Prospective, Multicenter Registry Study. JACC Cardiovasc Interv. 2017;10(16): 1607-1617. DOI: 10.1016/j.jcin.2017.05.059.Stuckey T.D., Kirtane A.J., Brodie B.R., Witzenbichler B., Litherland C., Weisz G., Rinaldi M.J., Neumann F.J., Metzger D.C., Henry T.D., Cox D.A., Duffy P.L., Mazzaferri E.L. Jr., Gurbel P.A., Mehran R., Généreux P., Ben-Yehuda O., Simonton C.A., Stone G.W. Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents: 2-Year Results of a Prospective, Multicenter Registry Study. JACC Cardiovasc Interv. 2017;10(16): 1607-1617. DOI: 10.1016/j.jcin.2017.05.059.

The authors declare that there are no conflicts of interest present.