Henry H.Ting  美国梅奥医学中心

    <International Circulation>: What are the common types of coronary stents currently used in clinical practice? For each， could you summarize their advantages and disadvantages? 

  《国际循环》：目前临床应用的冠脉支架有哪些类型？您来谈谈每种类型的优缺点有哪些？
    Prof Ting: The two most common types of coronary stents we use in clinical practice in the United States as well as China are drug-eluting stents and bare-metal stents. The main benefit of drug-eluting stents is the decrease in the risk of restenosis. Restenosis occurs when the blockage which has been treated returns within the first six to twelve months. The drug-eluting stents have revolutionized our treatment with coronary stents by decreasing that rate from approximately 15% - 30% with bare-metal stents to about 5% - 10% with drug-eluting stents. That is the main advantage of drug-eluting stents. That does come with a cost. With the drug-eluting stents， you have to take blood thinners， notably aspirin and clopidogrel， continuously for twelve months. If you stop that therapy， you are at very high risk of developing a blood clot in that stent. That is the main downside of using drug-eluting stents. The bare-metal stents have been around since 1994 and when they were originally introduced they revolutionized the way we treated coronary artery disease and blockages. The bare-metal stents have a higher risk of restenosis (as I said， 15%-30% as opposed to 5%-10%) but the good thing about bare-metal stents is that the risk of a blood clot is much lower and blood thinning medication (aspirin and clopidogrel) is only required for one month. In this day and age， I would estimate that about 75%-80% of procedures that will relieve blockages in coronary arteries are done with drug-eluting stents and 15%-20% done with bare-metal stents.

    Prof Ting:在中-美两国最常应用的支架不外乎药物洗脱支架（DES）和金属裸支架（BMS）。DES最大的优点在于有效降低再狭窄风险，而再狭窄的发生最常见于术后6-12个月。DES的应用无疑是支架技术革新的里程碑，它将BMS支架内再狭窄15-30%的数据减少到5-10%。但DES的应用会增加治疗费用，患者必须在术后坚持抗血小板治疗，持续服用阿司匹林，氯吡格雷至少12个月。如果间断药物治疗，支架内血栓的风险将大大增高，这是DES最大的劣势。BMS开始应用于1994年，开创了介入治疗冠脉疾患和狭窄的先河。BMS的缺点在于再狭窄率高（我之前所言相对于DES它的发生率为15%-30% vs 5%-10%），优点在于其支架内血栓风险低，且术后仅需服用阿司匹林和氯吡格雷片一个月。目前冠脉介入手术中大约有80%的手术会选用DES，而15-20%选用BMS。