| Abstract | Perkutana koronarna intervencija sa implantacijom stenta postala je standardna procedura u pacijenata sa koronarnom bolešću. Stentovi čine više od 80% intervencija u koronarnoj angioplastici. Dugoročni rezultati prohodnosti stentiranja ometani su restenozama koje su posljedica elastičnog „recoila“, hiperplazije neointime i remodeliranja žile. Revolucionarno otkriće koje je balon šireće i samošireće metalne stentove stavilo u drugi plan, upravo zbog smanjenja restenoze, je otkriće stentova koji otpuštaju lijekove (DES). Takav stent sastoji se od 3 komponente : stent, polimer i lijek. U prvih nekoliko dana izluči se najviše lijeka, a nakon 90 dana lijeka u stentu više nema; pacijent sada ima metalni stent. Trenutno su u široj upotrebi dva lijeka koja se koriste u DES sustavu; sirolimus i paclitaxel. Komercijalni stentovi sa tim lijekovima su Cypher stent sa sirolimusom i Taxus stent sa paclitaxelom. Prednost ima Cypher zbog manje incidencije angiografske restenoze. Osim sirolimusa i paclitaxela u DES sustavima kao antiproliferativni lijekovi koriste se i njihovi analozi; everolimus (Xcience V) i zotarolimus (Endeavor stent, Resolute, Resolute Integrity i Resolute Onyx stent). Istraživanja pokazuju da manju pojavu tromboze ima Xcience V (everolimus stent) u usporedbi sa Resolute-om (zotarolimus stent). Najnoviji iskorak u liječenju koronarnih bolesti predstavlja BVS stent; biorazgradivi stentovi koji nestaju u roku od dvije godine, a krvna žila ostaje onakva kakva je bila prije bolesti. Kao i sa svakim novim proizvodom, nakon prvobitne sumnjičavosti slijedi oduševljenje, a zatim se, nakon suočenja s problemima, očekuje racionalniji pristup. Kod DES-a se pokazao problem u vidu nešto većeg mortaliteta nakon duljeg praćenja. Razlog je brzo uočen, radilo se o pojavi vrlo kasne tromboze u stentu, a pripisana je djelomično vrlo kasnoj epitelizaciji. To je uzrokovalo naglo smanjenje upotrebe DES-a. Kako se radi o minimalnom broju incidenata u odnosu na ogroman broj pozitivnih učinaka, vjerojatno je potrebno vrijeme za donošenje racionalnih zaključaka, no opći je da su „DES ovdje, da ostanu“. |
| Abstract (english) | Percutaneous coronary intervention with stent implantation has become standard procedure in patients with coronary disease. Stents make up more than 80% of the interventions in coronary angioplasty. Long-term results of stenosis are obstructed by restenosis due to the elastic "recoil", neoplastic hyperplasia and vessel remodeling. The revolutionary discovery that put the balloon spills and solids metal stents in a second plan, precisely because of the reduction of restenosis, is the discovery of drug-eluting stents (DES). That kind of stent consists of 3 components: stent, polymer, and drug. In first few days, the highest drug counts, and 90 days after there is no drug in the stent ; the patient now has a metal stent. Currently, there are two more drugs being used in the DES system; sirolimus and paclitaxel. Commercial stents with these drugs are Cypher stent with sirolimus and Taxus stent with paclitaxel. Cypher has the advantage of less incidence of angiographic restenosis. In addition to sirolimus and paclitaxel in DES systems as their antiproliferative drugs, their analogs are also used; everolimus (Xcience V) and zotarolimus (Endeavor stent, Resolute, Resolute Integrity and Resolute Onyx stent). Studies show that the lower thrombosis has Xcience V (everolimus stent) compared to Resolute (zotarolimus stent). The latest advancement in the treatment of coronary diseases is the BVS stent; biodegradable stent that disappear within two years, and blood vessels remain the same as before the disease. As with every new product, after the initial suspicion comes enthusiasm, then, after facing the problems, a more rational approach is expected. DES was a problem in the form of a bitter mortality after long follow-up. The reason was quickly noticed, there was a very late thrombosis in the stent, and it was attributed to the partial late epithelialization. This has caused a sharp reduction in the use of DES. As the minimal number of incidents has been compared to a huge number of positive effects, it is likely that time is needed to make rational conclusions, but there is a general conclusion that "DES are here, to stay". |
