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1、再狭窄的讨论,动脉硬化(斑块) vs. 再狭窄,A,C,支架横截面病理结果,金属裸支架内狭窄,雷帕霉素涂层支架内膜光滑，无再狭窄,女性，71岁，成功雷帕霉素洗脱支架植入术后16个月死于脑卒中,图1 DES表面内皮化80%,箭头所指为支架远端（侧面）未被内皮覆盖,图2 DES表面内皮细胞呈点状不愈合,图3 内皮细胞间连接不良, 箭头所指为血小板聚集,“Eventually, the sun will set, DES will only delay the inevitable, late clinical results will fail to show long-term benefits
2、 because things must heal. Thats the way nature works.“ Dr.Renu Virmani,迟发性血栓DES安全吗？,DES in Diseased Human Coronary Artery,16 Months After SES Implantation,Guagliumi, et al. Circulation 2003;107:1340-1,LATE THROMBOSIS 62 yr old lady presenting with acute chest pain 1 yr 2 months following DES in LCX
3、. Aspirin and plavix was stopped 2 days prior to knee surgery,Potential mechanisms: Late stent thrombosis, malapostion, late restenosis,Chronic persistent inflammation,Hypersensitivity,Toxicity,? Infection,传统的Polymer的剥离,支架打开时因polymer粘连,拉拽, polymer形成网状剥离Polymer 从支架上被扯下来,裸露出金属表面,TCT 2004,传统的Polymer 的损伤,TCT 2004,EXCEL 可降解涂层药物支架,易于进入边支,EXCEL DES平台: S-stent ,较小的外径 高柔软性支撑力较好外表面平滑示踪性和血管顺应性好均一性扩张波环、开环结合的短臂设计， 血管覆盖较好 易于进入边支和穿越近端支架,EXCEL 支架球囊,命名压 6 atm 爆裂压 16 atm Tip prolife 0.019 Tip Length 1.52.0mm Crossing prolife 0.0390.046 ,介于半顺应与非顺应性之间的耐高压球囊,
