Daniel M Kolansky    宾夕法尼亚大学医学中心
    <International Circulation>: Stent thrombosis and in-stent restenosis remain significant issues in post-coronary angioplasty care despite advances in anti-platelet therapy and stent technology. Can you firstly just define in-stent restenosis because it is different from the restenosis seen with balloon angioplasty?

  《国际循环》：尽管抗血小板治疗和支架技术取得进步，支架内血栓和再狭窄仍为PCI手术的重要问题。您认为支架内再狭窄是否有别于球囊扩张引起的再狭窄？
    Dr Kolansky: In-stent restenosis involves a reaction after stent placement which includes vascular smooth muscle cell migration and proliferation resulting in neointimal hyperplasia in the weeks and months after stenting， and out to perhaps one year.  It occurs to a greater degree with bare-metal stents than with drug-eluting stents but can be seen with both types of stents. 

    Kolansky博士: 支架植入术后支架内再狭窄的发生与血管平滑肌细胞移行和增植导致术后数周至数月乃至1年内动脉内膜增生相关。其发生率在裸支架高于药物洗脱支架，但两者均有一定的发生率。
    <International Circulation>: Is there any new therapeutic progress in the field that you can share with us regarding in-stent restenosis?

  《国际循环》：关于支架内再狭窄治疗进展方面您有什么希望与我们分享？
    Dr Kolansky: The most recent data would suggest that treatment of in-stent restenosis is best accomplished using drug-eluting stenting. Particularly for bare-metal stents， there have been two major trials which compared the use of drug-eluting stents to vascular brachytherapy and found that drug-eluting stents had a better outcome for the treatment of in-stent restenosis. With regard to drug-eluting stents which develop restenosis， there is one trial which has suggested the benefit of repeat drug-eluting stenting for the treatment of drug-eluting stent restenosis. It is also useful to look at whether the in-stent restenosis is focal or diffuse. Diffuse restenosis will have a higher recurrence rate despite current treatment strategies.

    Kolansky博士: 近期研究表明支架内再狭窄的治疗最好使用DES.特别指出，与BMS相比，有两大临床试验结果表明DES的应用对于支架内再狭窄的远期预后较好。然而有关DES导致支架内再狭窄的问题，有研究表明最好还是应用DES再次治疗这种再狭窄。观察支架内再狭窄的形态是局限还是弥漫的病变也很有必要，因为弥漫的病变再狭窄率更高。