ЧРЕСКОЖНЫЕ КОРОНАРНЫЕ ВМЕШАТЕЛЬСТВА – СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА: ПРОФИЛАКТИКА ОСЛОЖНЕНИЙ И ПЕРСПЕКТИВЫ РАЗВИТИЯ
Аннотация
Антиагрегантная терапия – обязательная составляющая профилактики сердечно-сосудистых осложнений у пациентов с ишемической болезнью сердца (ИБС). Повреждение сосудистой стенки при выполнении чрескожных коронарных вмешательств (ЧКВ) сопровождается значительной активацией тромбоцитов и неизбежно повышает риск тромбообразования в зоне стентирования, особенно до завершения эндотелизации, как в случае реваскуляризации у пациентов с острыми коронарными синдромами, так и с хроническими формами ИБС. Эффективное предупреждение ишемических осложнений после ЧКВ диктует необходимость двойной антитромбоцитарной терапии, в том числе в комбинации с антикоагулянтной терапией. Длительность комбинированной терапии определяется клинической ситуацией, соотношением риска ишемических и геморрагических событий, оценка которых – неотъемлемая часть лечебно-диагностического процесса. Технологическое совершенствование коронарных интервенций направлено на точную оценку атеросклеротического поражения коронарных артерий и необходимость реваскуляризации, минимизацию повреждения сосудистой стенки, ускорение эндотелизации, сокращение длительности антитромботической терапии без потери долговременной эффективности реваскуляризации и повышения риска тромбоза стента. В представленном обзоре обсуждаются профилактика осложнений после ЧКВ с фокусом на антитромботическую терапию, а также перспективные технологии ЧКВ.
Литература
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