• 上海交通大學(xué)附屬第六人民醫(yī)院胸心外科 , 上海 200233;

第一代金屬裸支架和第二代涂層支架介入治療冠狀動脈粥樣硬化性心臟?。ü谛牟。┮训玫綇V泛應(yīng)用。由于長期存在金屬支架異物刺激及其攜帶的藥物擾亂血管壁各層細(xì)胞生長,引起支架內(nèi)再狹窄和血管栓塞,遠(yuǎn)期仍有較多的主要心血管不良事件發(fā)生和需要再血管化治療。因此,由聚酯、聚碳酸酐及聚磷酸酯等高分子材料制備的完全可生物降解吸收支架及藥物洗脫支架應(yīng)運而生,其中聚乳酸( poly-lactic acid,PLA)、聚羥基乙酸( poly-glycolic acid,PGA)、殼聚糖、聚己內(nèi)酯( poly-caprolactone,PCL)及一些共聚物如聚乳酸 /聚羥基乙酸共聚物( poly-lactic-coglycolic acid,PLGA)材料制備的心血管植入支架的安全性、組織及血液相容性已得到證實,然而這些支架具有各自的缺點,如 PLA降解較慢質(zhì)硬易斷裂柔韌性不足,PGA降解較快質(zhì)軟支撐力不足,支架降解太快或者太慢,均難以達到有效支撐,支架植入后容易出現(xiàn)血管損傷、彈性回縮,導(dǎo)致血管再狹窄及血栓形成,遠(yuǎn)期效果不佳。通過優(yōu)化組合不同摩爾比的 PLA和 PGA及殼聚糖涂層,可以獲得具有更好的生物相容性、適度的降解速率(約 3~ 6個月完全降解)、足夠的機械強度、較低的炎癥反應(yīng)和伸展度良好的復(fù)合材料,從而為制備完全生物可降解冠狀動脈支架奠定實驗基礎(chǔ)。

引用本文: 郭清奎,呂志前. 生物可降解材料聚乳酸/聚羥基乙酸復(fù)合殼聚糖在人工冠狀動脈血管支架制備中的應(yīng)用. 中國胸心血管外科臨床雜志, 2012, 19(3): 314-317. doi: 復(fù)制

1.  Tamai H, Igaki K, Kyo E, et al. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation, 2000, 102(4):399-404.
2.  Tamai H, Igaki K, Kyo E, et al. A biodegradable poly-l-lactic acid coronary stent in porcine coronary artery. J Interv Cardiol, 1999, 12(6):443-445.
3.  Di Mario C, Griffiths H, Goktekin O, et al.Drug-eluting bioabsorbable magnesium stent. J Interv Cardiol, 2004, 17(6):391-395..
4.  Erbel R, Di Mario C, Bartunek J, et al.Temporary scaffolding of coronary arteries with bioabsorbable magnesium stents:a prospective, non-randomised multicentre trial. Lancet, 2007, 369(9576):1869-1875..
5.  Zilberman M, Schwade ND, Eberhart RC. Protein-loaded bioresorbable fibers and expandable stents:Mechanical properties and protein release. J Biomed Mater Res B Appl Biomater, 2004, 69(1):1-10.
6.  Li SM, Vert M. Biodegradable polymers:polyesters. In Encyclopedia of Controlled Drug Delivery. Mathiowitz E. Editor. Hoboken:John Wiley & Sons, 1999. 71-93.
7.  Zidar J, Lincoff AM, Stack R. Biodegradable stents. In:Textbook of Interventional Cardiology,Second Edition. Topol EJ Editor. Philadelphia, PA:W.B. Saunders, 1994. 787-802.
8.  Stack RS, Califf RM, Phillips HR, et al. Interventional cardiac catheterization at Duke Medical Center:new interventional technology. Am J Cardiol,1998, 62(10 Pt 2):3F-24F.
9.  Vogt F, Stein A, Rettemeier G, et al.Long-term assessment of a novel biodegradable paclitaxel-eluting coronary polylactide stent. Eur Heart J, 2004, 25(15):1330-1340.
10.  Venkatraman SS, Tan LP, Joso JF, et al. Biodegradable stents with elastic memory. Biomaterials, 2006, 27(8):1573-1578.
11.  REVA medical announces enrollment of first patients in the RESORB clinical trial-novel bioresorbable coronary stent begins clinical evaluation.2011[2007-06-02] http://www.pcronline.com/News/Press-releases/REVA-Medical-Announces-Enrollment-of-First-Patients-in-the-RESORB-Clinical-Trial-Novel-Bioresorbable-Coronary-Stent-Begins-Clinical-Evaluation.
12.  Ormiston JA, Webster MW, Armstrong G. First-in-human implantation of a fully bioabsorbable drug-eluting stent:the BVS poly-l-lactic acid everolimus-eluting coronary stent. Catheter Cardiovasc Interv, 2007, 69(1):128-131.
13.  Abbott Vascular. Abbott’s ABSORB bioresorbable vascular scaffold demonstrates positive one-year safety and efficacy results.2011[2011-04-30] http://www.abbott.com/news-media/press-releases/.
14.  郭正, 張佩華. 聚乙交酯、聚丙交酯及聚乙交酯丙交酯纖維的研究進展. 合成纖維, 2009, 38(3):7-11.
15.  吳雙全, 張佩華, 郭正. 不同比例PGA/PLA編織線的體外降解性能. 東華大學(xué)學(xué)報(自然科學(xué)版), 2009, 35(3):274-278, 303.
16.  Thomas AC, Campbell GR, Campbell JH.Advances in vascular tissue engineering.Cardiovasc Pathol, 2003, 12(5):271-276.
17.  孫慶蘭, 張華, 張西正, 等. 血管組織工程支架材料的研究進展. 化工新型材料, 2009, 37(11):1-4.
18.  陶沙, 張佩華, 郭正, 等. 組織工程人工肌腱支架的制備工藝及降解性能. 東華大學(xué)學(xué)報(自然科學(xué)版), 2009, 35(2):153-156, 185.
19.  Singla AK, Chawla M.Chitosan:some pharmaceutical and biological aspects. J Pharm Pharmacol, 2001, 53(8):1047-1067.
20.  楊慶, 郯志清, 梁伯潤, 等. 高強度甲殼質(zhì)類纖維的開發(fā). 東華大學(xué)學(xué)報(自然科學(xué)版), 2002, 28(5):110-114, 118.
21.  郯志清, 沈新元, 趙炯心, 等. 殼聚糖纖維的制備及應(yīng)用. 針織工業(yè), 2002, 30(4):44-46.
22.  楊慶, 沈新元, 郯志清, 等. 醋酸纖維素/殼聚糖紡絲原液的流變性能研究. 纖維素與科學(xué)技術(shù), 2006, 14(2):27-34.
23.  于雷, 陳紅紅, 郯志清, 等. 125I籽源照射時可降解涂層載體支架的體內(nèi)降解和組織相容性. 復(fù)旦學(xué)報(醫(yī)學(xué)版), 2007, 34(2):233-238.
24.  沈新元, 吉亞麗, 郯志清, 等. 甲殼素類生物醫(yī)學(xué)纖維的制備技術(shù)及應(yīng)用. 材料導(dǎo)報, 2008, 22(6)::1-5.
25.  Pfisterer M, Brnnner-La Rocca HP, Buser PT, et al.Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents:an obsmwational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol, 2006, 48(12):2584-2591.
26.  Zartner P, Buettner M, Singer H,et al. First biodegradable metal stent in a child with congenital heart disease:evaluation of macro and histopathology. Catheter Cardiovasc Interv, 2007, 69(3):443-446.
27.  張袆, 呂志前. 完全生物可降解冠狀動脈支架的研究現(xiàn)狀與展望. 生物醫(yī)學(xué)工程與臨床, 2010, 14(2):171-175.
28.  Williams D.New interests in magnesium.Med Device Technol,2006,17(3):9-10.
29.  Nobuyoshi M, Kimura T, Nosaka H, et al. Restenosis after successful percutaneous transluminal angioplasty:serial angiographic follow-up of 229 patients. J Am Coll Cardiol, 1988, 12(3):616-623.
  1. 1.  Tamai H, Igaki K, Kyo E, et al. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation, 2000, 102(4):399-404.
  2. 2.  Tamai H, Igaki K, Kyo E, et al. A biodegradable poly-l-lactic acid coronary stent in porcine coronary artery. J Interv Cardiol, 1999, 12(6):443-445.
  3. 3.  Di Mario C, Griffiths H, Goktekin O, et al.Drug-eluting bioabsorbable magnesium stent. J Interv Cardiol, 2004, 17(6):391-395..
  4. 4.  Erbel R, Di Mario C, Bartunek J, et al.Temporary scaffolding of coronary arteries with bioabsorbable magnesium stents:a prospective, non-randomised multicentre trial. Lancet, 2007, 369(9576):1869-1875..
  5. 5.  Zilberman M, Schwade ND, Eberhart RC. Protein-loaded bioresorbable fibers and expandable stents:Mechanical properties and protein release. J Biomed Mater Res B Appl Biomater, 2004, 69(1):1-10.
  6. 6.  Li SM, Vert M. Biodegradable polymers:polyesters. In Encyclopedia of Controlled Drug Delivery. Mathiowitz E. Editor. Hoboken:John Wiley & Sons, 1999. 71-93.
  7. 7.  Zidar J, Lincoff AM, Stack R. Biodegradable stents. In:Textbook of Interventional Cardiology,Second Edition. Topol EJ Editor. Philadelphia, PA:W.B. Saunders, 1994. 787-802.
  8. 8.  Stack RS, Califf RM, Phillips HR, et al. Interventional cardiac catheterization at Duke Medical Center:new interventional technology. Am J Cardiol,1998, 62(10 Pt 2):3F-24F.
  9. 9.  Vogt F, Stein A, Rettemeier G, et al.Long-term assessment of a novel biodegradable paclitaxel-eluting coronary polylactide stent. Eur Heart J, 2004, 25(15):1330-1340.
  10. 10.  Venkatraman SS, Tan LP, Joso JF, et al. Biodegradable stents with elastic memory. Biomaterials, 2006, 27(8):1573-1578.
  11. 11.  REVA medical announces enrollment of first patients in the RESORB clinical trial-novel bioresorbable coronary stent begins clinical evaluation.2011[2007-06-02] http://www.pcronline.com/News/Press-releases/REVA-Medical-Announces-Enrollment-of-First-Patients-in-the-RESORB-Clinical-Trial-Novel-Bioresorbable-Coronary-Stent-Begins-Clinical-Evaluation.
  12. 12.  Ormiston JA, Webster MW, Armstrong G. First-in-human implantation of a fully bioabsorbable drug-eluting stent:the BVS poly-l-lactic acid everolimus-eluting coronary stent. Catheter Cardiovasc Interv, 2007, 69(1):128-131.
  13. 13.  Abbott Vascular. Abbott’s ABSORB bioresorbable vascular scaffold demonstrates positive one-year safety and efficacy results.2011[2011-04-30] http://www.abbott.com/news-media/press-releases/.
  14. 14.  郭正, 張佩華. 聚乙交酯、聚丙交酯及聚乙交酯丙交酯纖維的研究進展. 合成纖維, 2009, 38(3):7-11.
  15. 15.  吳雙全, 張佩華, 郭正. 不同比例PGA/PLA編織線的體外降解性能. 東華大學(xué)學(xué)報(自然科學(xué)版), 2009, 35(3):274-278, 303.
  16. 16.  Thomas AC, Campbell GR, Campbell JH.Advances in vascular tissue engineering.Cardiovasc Pathol, 2003, 12(5):271-276.
  17. 17.  孫慶蘭, 張華, 張西正, 等. 血管組織工程支架材料的研究進展. 化工新型材料, 2009, 37(11):1-4.
  18. 18.  陶沙, 張佩華, 郭正, 等. 組織工程人工肌腱支架的制備工藝及降解性能. 東華大學(xué)學(xué)報(自然科學(xué)版), 2009, 35(2):153-156, 185.
  19. 19.  Singla AK, Chawla M.Chitosan:some pharmaceutical and biological aspects. J Pharm Pharmacol, 2001, 53(8):1047-1067.
  20. 20.  楊慶, 郯志清, 梁伯潤, 等. 高強度甲殼質(zhì)類纖維的開發(fā). 東華大學(xué)學(xué)報(自然科學(xué)版), 2002, 28(5):110-114, 118.
  21. 21.  郯志清, 沈新元, 趙炯心, 等. 殼聚糖纖維的制備及應(yīng)用. 針織工業(yè), 2002, 30(4):44-46.
  22. 22.  楊慶, 沈新元, 郯志清, 等. 醋酸纖維素/殼聚糖紡絲原液的流變性能研究. 纖維素與科學(xué)技術(shù), 2006, 14(2):27-34.
  23. 23.  于雷, 陳紅紅, 郯志清, 等. 125I籽源照射時可降解涂層載體支架的體內(nèi)降解和組織相容性. 復(fù)旦學(xué)報(醫(yī)學(xué)版), 2007, 34(2):233-238.
  24. 24.  沈新元, 吉亞麗, 郯志清, 等. 甲殼素類生物醫(yī)學(xué)纖維的制備技術(shù)及應(yīng)用. 材料導(dǎo)報, 2008, 22(6)::1-5.
  25. 25.  Pfisterer M, Brnnner-La Rocca HP, Buser PT, et al.Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents:an obsmwational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol, 2006, 48(12):2584-2591.
  26. 26.  Zartner P, Buettner M, Singer H,et al. First biodegradable metal stent in a child with congenital heart disease:evaluation of macro and histopathology. Catheter Cardiovasc Interv, 2007, 69(3):443-446.
  27. 27.  張袆, 呂志前. 完全生物可降解冠狀動脈支架的研究現(xiàn)狀與展望. 生物醫(yī)學(xué)工程與臨床, 2010, 14(2):171-175.
  28. 28.  Williams D.New interests in magnesium.Med Device Technol,2006,17(3):9-10.
  29. 29.  Nobuyoshi M, Kimura T, Nosaka H, et al. Restenosis after successful percutaneous transluminal angioplasty:serial angiographic follow-up of 229 patients. J Am Coll Cardiol, 1988, 12(3):616-623.