Publikationsserver der Universitätsbibliothek Marburg

Titel:Vergleich aktiv und passiv beschichteter Stents im Hinblick auf Restenoseprophylaxe - eine vergleichende tierexperimentelle Studie
Autor:Reinke, Julia Margaretha
Weitere Beteiligte: Kalinowski, Marc ( PD Dr.)
Veröffentlicht:2011
URI:https://archiv.ub.uni-marburg.de/diss/z2011/0550
URN: urn:nbn:de:hebis:04-z2011-05507
DOI: https://doi.org/10.17192/z2011.0550
DDC: Medizin
Titel (trans.):Active And Passive Stent Coating - is in-stent restenosis preventable?
Publikationsdatum:2011-08-22
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
bare-metal stent, stent, biomimicry, Neointima, Drug-eluting Stent, Sirolimus, restenosis, Nanocoating, neointima, Stent, Sirolimus, drug-eluting stent, Bare-Metal Stent, Restenose

Zusammenfassung:
Zusammenfassend kann aus dieser Studie entnommen werden, dass der getestete Ramapycin-Stent (+ Camouflage® Nanocoating) in der Lage ist die Neointimaproliferation und damit die Gefahr der Restenose signifikant zu senken. Weiterhin scheint dieser Stent durch seine antithrombogene Beschichtung in der Lage zu sein die Einheilung in die Gefäßwand zu verbessern, was möglicherweise durch die verbesserte vaskuläre Einheilung zu weniger Stentthrombosen führt. Die bessere Biokompatibilität und die damit verbundene verbesserte Einheilung könnten außerdem dazu führen, dass die momentan noch zwingend notwendige antikoagulative Therapie verkürzt oder herunterdosiert werden kann. Durch die Beschichtung mit Camouflage® Nanocoating ist es gelungen die erzielte Senkung der Restenosen durch eine besonders gute Biokompatibilität zu ergänzen. Gemeinsam sind diese beiden Komponenten möglicherweise in der Lage eine wiederholt verminderte Rate an Restenosen und Stentthrombosen zu erzielen. Weiteren Forschungsbedarf gibt es an vielen Stellen. Diese Studie ist als Pilotstudie anzusehen, die eine Möglichkeit der Verbesserung in der Therapie von Arteriosklerose im weitesten Sinne aufzeigt. Zukünftige Studien müssen evaluieren, ob 1. Sirolimus tatsächlich der optimale Wirkstoff ist, ob 2. das verwandte Polymer die beste Bioverträglichkeit hat und ob 3. die Eigenschaften des Stentgerüstes noch weiter optimiert werden können. Der Konkurrenzkampf zwischen PES und SES ist noch immer nicht endgültig entschieden und weitere Wirkstoffe wie Everolimus und Zotarolimus müssen ebenso evaluiert werden, wie neue Konzepte, die ohne Polymere auskommen oder komplett biodegenerable sind. Ebenso bieten DEB möglicherweise eine attraktive Alternative zu den bestehenden Therapiemöglichkeiten. Es sollten in Zukunft Studien durchgeführt werden, die eine genaue Evaluation der „neointimal coverage“ und der Inzidenz von Stenthrombosen vornehmen und auch deren molekulare Ursachen genauer erforschen, um die Überlegenheit des Rapamycin-Stents ( + Camouflage®) weiter zu festigen. Auch das Stentmaterial sollte noch einmal gesondert evaluiert werden. Es wären Studien sinnvoll, die BMS und DES mit dem Camouflage®-Stent vergleichen. Weiterhin sollte der Rapamycin-Stent (+Camouflage®) mit BMS und SES (ohne Camouflagebeschichtung) verglichen werden. Dies wäre sinnvoll, um die vielen Variablen zu minimieren und exaktere Daten für die Weiterentwicklung der DES zu generieren. Wenn die präklinische Phase abgeschlossen ist, muss das Konzept Rapamycin (+ Camouflage®) in der praktischen Anwendung am Patienten ebenfalls seine Wirksamkeit unter Beweis stellen. Erst dann können endgültige Aussagen zur Überlegenheit dieses Konzeptes gegenüber herkömmlichen Stents und konkurrierenden Verfahren gemacht werden.

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