药物洗脱冠脉支架现状和发展趋势培训课件

药物洗脱冠脉支架现状和发展趋势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：Firebird

FirebirdⅡPartner

Nano(R&D)

Excel紫杉醇支架Background:

breakthroughtechnologiesDriverofrestenosisrecoilneointimaformationimplantationtechniquemechanicalstabilizationofacuteresultlocaldeliveryof

anti-proliferativeagents5%BMSPTCADESNeedforrevascularization40%20%‘fool-proof’deliverysystem

?药物支架的现状基本解决了再狭窄的问题

结束了二十年来介入器械与再狭窄作斗争的历史存在远期血栓的安全性风险技术变革解决临床问题安全性问题再狭窄问题BMSvsDESBMSPESSESBMSConclusions:BMSshowedfargreaterendothelializationthanDESLackofcoveragehighlightedinareasofoverlapLesssurfacecoveragebyendothelialcellsinPESthanSESDelayedendothelializationFinnetal.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)Selectivecoatingonthe

outsidesurfaceofthestentReduceddrug/polymerLumenalsurfaceBMSDrugonlywhereneededLabcoatJA™CoatingTechnologyBiodegradable

Drug/Carrier:BiolimusA9®/Poly(LacticAcid)50:50mixabluminalsurfaceonly(contactsvesselwall)15µmetercoatingthicknessdegradesin9monthsreleasingCO2+waterStentPlatform:stainlesssteel(112m)

corrugatedring,quadrature-link™designradiuslinkenhancesaxialfatiguelifeParyleneDurablePrimerCoating:5µmeterthick,encapsulatesstentpreventssurfacemetalionmigrationbiostable+athrombogenic*BioMatrix®IIStentPlatformDesignBIOFLEX™IBioFlexIstent*DataperNHLBIsponsoredstudy,availablefromBSIConorDrugReleaseTechnology

DrugReservoirLuminalBarrierLayerSimpleDrugReservoirUniformReleaseSingleDrugStructureMultipleDrugStructuresDrugAreleased

toarterialwallBarrierlayerDrugBreleased

intobloodstreamTwoDrugs,OneWellTwoDrugs,TwoWellsTwoDirectionsLuminalBarrierMuralBarrierMuralSideACompletelyPolymer-FreeStrategy

TransluminaYUKON®ChoiceDES

Polymer-freecoatingUniqueroughenedsurfaceAdjustabledosageforindividualizedtreatmentFreechoiceofdrugsMIVPolymer-freeDES乐普公司

Nano无载体药物洗脱支架

纳米微孔载药载药后，支架表面

均匀一致ResultsfromNanoFIMclinicalstudy:

LLat6-8MonthsNanoTMPartnerTM与裸金属支架相同的安全性，与药物支架相同的有效性0.370.260.340.30DesignPrincipleofEPCCapturingand

DrugElutingCombinationStentEPCCapturingandDrugElutingCombinationStent外表面已喷涂雷帕霉素Inner

surface-CD34antibodyOutersurface-RapamycinRAPAMYCINAdsorptionprincipalofCD34antibody

onthestent’ssurfacePorousadsorptionChargeadsorption＋＋＋＋＋＋＋＋YYYYYYYCD34antibodycoatingPatents：PCT/CN2007/002964TheactivityofCD34antibodyoftheinnersurface

TheinnersurfaceofBMSImmerseinKG-1acellsuspensionstainedbyDAPI(CD34+Cell,ATCC)

BMSCombinationstentTheinnersurfaceofCombinationstentPhotobymicroscopeEndotheliumAppraisement

EMMorphologyonthe7thdayBMSCD34stentCombinationstentAnimalExperimentalResultsinporcine-QCAP<0.05REVABioresorbableCoronaryStent发展趋势新一代