<International Circulation> : There was some discussion at the end of the presentations on DES but do you think that these bioabsorbable scaffolds will replace metal stents in the future?

　　《国际循环》:在DES的展会结束时有一些讨论，您认为生物可降解支架未来将取代金属支架吗？

　　Prof.  Patrick:  Yeah my personal opinion is that it will be the case.  Why? Because we used the metal in 1986 because we had nothing else， and you want to maintain the vessel patency after a balloon angioplasty and you use metal but metal is basically too strong for the vessel.  We are talking about 900mm of mercury as a radial stress and you do not need that to keep a vessel open， 400mm would be enough.  So once you have implanted the stent it is a permanent implant， basically the forensic pathologists， over 100 years， if they find a body， they will find the metal in the heart and they will ask ‘Why were they putting metal in the coronary arteries?’ so the idea is really to suppress the cage because these metal cage is blocking a lot of good physiologic response.  A vessel is supposed to be pulsatile and the pulsatility is very important for the metabolism of the wall.  The vessel has to feel the flow， we call that shear stress， that trigger it to vasodilate， so the whole metabolism of the vessel can only be expressed when the vessel is free and when you put in these metallic cages， you block all the action because the fact that the segment proximal is pulsatile and this is fixed， you can imagine that it is creating a lot of trouble locally.  So I think everybody agrees that if we could replace the metal we should do it， of course the polymer is less strong than the metal so there is a whole process of education.  It is a scaffold， it is not something to dilate， it is something to put after the dilatation.  That is the reason why we use the word “scaffold” and we no longer use the word “stent” and so far we use either the magnesium， which is a metal， or the polylactide.  Now the polylactide， does not have the regular force of the metal and that creates in the community a lot of questions and a lot of education.

　　Patrick教授:我个人的观点是，确实会取代。为什么这么说呢？金属支架在1986年开始被使用时，我们没有其他的替代选择。在施行球囊血管成形术后，为保持血管处于开放状态，金属支架被置入，但这种支架对于血管来说太硬。我们这里讨论的是径向应力900mm水银柱的支架，实际上400mm水银柱的就足够了。因此，一旦置入永久性金属支架，那100年后，法医可能会在患者心脏中发现金属，他们会问：“为什么在冠状动脉里放入金属？”这种想法真的会抑制这种支架的发展，因为金属支架阻断了许多重要的、对身体有益的生理应答。血管具有搏动性，且这种搏动性对管壁的新陈代谢非常重要，血管能感受到血液的流动，我们称之为剪应力，这触发了血管舒张，因此只有在血管处于通畅状态下，它才能进行正常的新陈代谢。而置入金属支架后，血管的活动被阻断，近心端血管的搏动被固定，这就给整个心脏循环造成很许多局部的麻烦。因此，我认为所有人都会同意取代金属支架这一想法。当然，可聚合物的概念没有金属支架那样深入人心，所以还需要更多的宣教。这是一种支架，而非仅仅作为一种扩张器来使用，因此置入这种支架是非常了不起的。这就是为什么我一直使用“scaffold” 这个词而不再用“stent”这个词的原因。目前我们使用的支架材质一般是镁-- 一种金属，或者是聚交酯。聚交酯不会产生金属支架所带来的问题。

　　<International Circulation>: When you first put the scaffolds in place， if you have a polymer or a bioabsorbable scaffold， are there problems with initial events because you are not getting the same amount of expansion of the artery as you are with the metal stents?

　　《国际循环》:在首次置入聚合物或生物可降解支架时，会不变应为无法产生金属支架那样的扩张程度而带来一些问题？

　　Prof. Patrick:  Yes that is correct.  The point is that the keyword is preparation.  You have to open the vessel so we have a tendency to go back to cutting balloon or sculpting balloon to prepare the lesion and open the vessel completely and then we just scaffold after that.

　　Patrick教授:  这种想法是正确的，关键是早期准备。为了可以有余地对球囊进行调整以适应病变，你必须先开放血管，完全开放血管后才能置入支架。