Therapeutic strategies to combat neointimal hyperplasia in vascular grafts.
Therapeutic strategies to combat neointimal hyperplasia in vascular grafts.
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DOI：
10.1586/erc.12.33
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发表时间：
2012-05
影响因子：
2
通讯作者：
Dardik A
中科院分区：
文献类型：
--
作者：
Collins MJ;Li X;Lv W;Yang C;Protack CD;Muto A;Jadlowiec CC;Shu C;Dardik A
静脉和假体移植物等旁路导管中的新内膜增生（NIH）是限制血管介入治疗长期成功的重要临床实体。尽管导管中发生的 NIH 与损伤后在天然动脉中发生的 NIH 具有许多相同的特征，但血管移植物暴露于容易发生 NIH 的独特环境，包括与静脉处理相关的手术创伤、造成低流量区域的血流动力学变化以及导管与宿主环境之间的生物相容性差异。已经开发出多种不同的方法，包括新颖的手术技术和靶向基因疗法，以针对和预防 NIH 的病因。最近，PREVENT 试验是血管外科领域首个旨在预防 NIH 的分子生物学试验，但未能改善临床结果，突显出对血管移植中导致 NIH 的途径了解不完全。在这篇综述中，我们的目的是总结静脉和合成移植物中 NIH 形成的病理生理学途径，并讨论当前和潜在的正在研究中可能限制血管移植物中 NIH 的机械和分子方法。
Neointimal hyperplasia (NIH) in bypass conduits such as veins and prosthetic grafts is an important clinical entity that limits the long-term success of vascular interventions. Although the development of NIH in the conduits shares many of the same features of NIH that develops in native arteries after injury, vascular grafts are exposed to unique circumstances that predispose them to NIH, including surgical trauma related to vein handling, hemodynamic changes creating areas of low flow, and differences in biocompatibility between the conduit and the host environment. Multiple different approaches, including novel surgical techniques and targeted gene therapies, have been developed to target and prevent the causes of NIH. Recently, the PREVENT trials, the first molecular biology trials in vascular surgery aimed at preventing NIH, have failed to produce improved clinical outcomes, highlighting the incomplete knowledge of the pathways leading to NIH in vascular grafts. In this review, we aim to summarize the pathophysiologic pathways that underlie the formation of NIH in both vein and synthetic grafts and discuss current and potential mechanical and molecular approaches under investigation that may limit NIH in vascular grafts.