药物洗脱冠脉支架现状和发展趋势课件

药物洗脱冠脉支架现状和发展趋势 蒲忠杰Ph D 乐普 北京 医疗器械股份有限公司 目录 药物支架的现状存在的安全性问题解决的可能途径降低高分子载体的安全性风险发展完全可降解支架优化血小板治疗发展趋势 国产药物支架 微创 乐普 吉威 垠亿 FirebirdFirebird PartnerNano R D Excel 紫杉醇支架 Background breakthroughtechnologies Driverofrestenosis recoil neointimaformation implantationtechnique mechanicalstabilizationofacuteresult localdeliveryofanti proliferativeagents fool proof deliverysystem BMSvsDES BMS PES SES BMS Conclusions BMSshowedfargreaterendothelializationthanDESLackofcoveragehighlightedinareasofoverlapLesssurfacecoveragebyendothelialcellsinPESthanSES Delayedendothelialization Finnetal Circulation 2005 112 270 278 内皮化延迟是问题的核心 缺乏系统性的基础研究 未明确延迟内皮化的关键因素 药物 载体 交互作用 促进内皮化的可能途径减少与药物支架相关的安全因素和促进内皮化的途径如何接合 解决远期血栓的途径 支架设计药物 有效成分高分子载体 非绝对有效成分支架平台 无直接关联 新一代药物支架的发展方向 减少高分子载体的有害作用发展完全可降解支架 DirectionalDrugDelivery ablumenalpreference SelectivecoatingontheoutsidesurfaceofthestentReduceddrug polymerLumenalsurfaceBMSDrugonlywhereneeded LabcoatJA CoatingTechnology BiodegradableDrug Carrier BiolimusA9 Poly LacticAcid 50 50mixabluminalsurfaceonly contactsvesselwall 15 metercoatingthicknessdegradesin9monthsreleasingCO2 water StentPlatform stainlesssteel 112 m corrugatedring quadrature link designradiuslinkenhancesaxialfatiguelife ParyleneDurablePrimerCoating 5 meterthick encapsulatesstentpreventssurfacemetalionmigrationbiostable athrombogenic BioMatrix IIStentPlatformDesign BIOFLEX I DataperNHLBIsponsoredstudy availablefromBSI ConorDrugReleaseTechnology DrugReservoir LuminalBarrierLayer SimpleDrugReservoirUniformRelease SingleDrugStructure MultipleDrugStructures DrugAreleasedtoarterialwall Barrierlayer DrugBreleasedintobloodstream TwoDrugs OneWell TwoDrugs TwoWellsTwoDirections LuminalBarrier MuralBarrier MuralSide ACompletelyPolymer FreeStrategyTransluminaYUKON ChoiceDES Polymer freecoatingUniqueroughenedsurfaceAdjustabledosageforindividualizedtreatmentFreechoiceofdrugs MIVPolymer freeDES 乐普公司Nano无载体药物洗脱支架 ResultsfromNanoFIMclinicalstudy LLat6 8Months 与裸金属支架相同的安全性 与药物支架相同的有效性 DesignPrincipleofEPCCapturingandDrugElutingCombinationStent EPCCapturingandDrugElutingCombinationStent 外表面已喷涂雷帕霉素 Innersurface CD34antibody Outersurface Rapamycin RAPAMYCIN AdsorptionprincipalofCD34antibodyonthestent ssurface Patents PCT CN2007 002964 TheactivityofCD34antibodyoftheinnersurface TheinnersurfaceofBMS ImmerseinKG 1acellsuspensionstainedbyDAPI CD34 Cell ATCC BMS Combinationstent TheinnersurfaceofCombinationstent Photobymicroscope EndotheliumAppraisementEMMorphologyonthe7thday BMSCD34stentCombinationstent AnimalExperimentalResultsinporcine QCA P 0 05 REVABioresorbableCoronaryStent 发展趋势 新一代药物支架将在保