经皮冠状动脉介入治疗在冠状动脉生理学指导和基于设备的冠状动脉血运重建策略现代化方面的最新进展

摘要(中文译文)

冠状动脉疾病（CAD）仍然是全球范围内致病和致死的主要原因。过去三十年间，经皮冠状动脉介入治疗（PCI）已从一种解剖学血运重建技术演变为一种基于精准医学、以生理学和影像学为指导的治疗策略，能够应对日益复杂的冠状动脉病变。本综述旨在批判性地审视当代PCI的进展，尤其侧重于冠状动脉生理学、血管内影像学与新一代器械技术的整合。我们综合了里程碑式随机试验、荟萃分析及近期高影响力研究的证据，以评估这些进展如何重塑了复杂冠状动脉疾病中的临床决策、手术优化及长期预后。我们使用PubMed、Google Scholar和美国国家医学图书馆数据库进行了全面的叙述性文献综述。综述聚焦于生理学指导的PCI、药物洗脱支架的演变、血管内影像学、复杂临床情境下的PCI（包括左主干病变及冠状动脉旁路移植术后解剖结构），以及新兴辅助技术。结构性干预被选择性讨论，以将基于导管的心血管治疗的更广泛演变置于背景之中。当代PCI已因生理学指导的病变评估、先进的血管内影像学和改进的支架平台而发生变革，使得复杂冠状动脉解剖结构的治疗更加安全有效。近期试验的证据既凸显了生理学指导PCI的优势，也揭示了其局限性，尤其是在多支血管病变和CABG术后疾病中，强调了整合解剖学-生理学方法的必要性。器械工程、机器人辅助及辅助药物治疗的进步进一步提升了手术精准度和预后。新兴技术，包括药物涂层球囊、可吸收支架以及创新的生物性和无细胞治疗策略，展示了冠状动脉介入不断扩展的转化前景。PCI的现代化反映了向精准指导、循证冠状动脉血运重建的范式转变。尽管技术进步拓宽了PCI的适用范围并改善了手术预后，但最佳血运重建策略仍须个体化，并以强有力的临床证据为基础。

Abstract

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Over the past three decades, percutaneous coronary intervention (PCI) has evolved from a anatomical revascularization technique into a precision-based, physiology- and imaging-guided therapeutic strategy capable of addressing increasingly complex coronary disease. This review aims to critically examine contemporary advances in PCI, with particular emphasis on the integration of coronary physiology, intravascular imaging, and next-generation device technologies. We synthesize evidence from landmark randomized trials, meta-analyses, and recent high-impact studies to evaluate how these advances have reshaped clinical decision-making, procedural optimization, and long-term outcomes in complex coronary artery disease. A comprehensive narrative review of the literature was conducted using PubMed, Google Scholar, and the National Library of Medicine databases. The review focuses on physiology-guided PCI, drug-eluting stent evolution, intravascular imaging, PCI in complex clinical settings (including left main disease and post-coronary artery bypass grafting anatomy), and emerging adjunctive technologies. Structural interventions are discussed selectively to contextualize the broader evolution of catheter-based cardiovascular therapies. Contemporary PCI has been transformed by physiology-guided lesion assessment, advanced intravascular imaging, and improved stent platforms, enabling safer and more effective treatment of complex coronary anatomy. Evidence from recent trials highlights both the strengths and limitations of physiology-guided PCI, particularly in multivessel and post-CABG disease, underscoring the need for integrated anatomy-physiology approaches. Advances in device engineering, robotic assistance, and adjunctive pharmacotherapy have further refined procedural precision and outcomes. Emerging technologies, including drug-coated balloons, resorbable scaffolds, and innovative biologic and cell-free therapeutic strategies, illustrate the expanding translational landscape of coronary intervention. The modernization of PCI reflects a paradigm shift toward precision-guided, evidence-based coronary revascularization. While technological advances have broadened the scope of PCI and improved procedural outcomes, optimal revascularization strategies must remain individualized and grounded in robust clinical evidence.

如何引用

Frontiers in medicine 的其他文献

• 肺结核后肺病中的肺康复：一项系统评价
• 定量评估3D打印生理可视化工具在提高实习生知识记忆和应用方面的作用
• 免疫治疗和肺部消融治疗时代非小细胞肺癌远隔效应的定义：叙述性综述
• 表观遗传学修饰在癌症相关成纤维细胞中的作用
• 美国成年人睡眠障碍与白内障之间的关联：一项横断面研究
• 康复新对种植体支持康复期间牙周炎患者牙周和咀嚼功能的影响
• 特发性肺纤维化定量肺超声参数与肺功能的相关性分析：一项观察性研究
• 单门胸腔镜肺肿瘤切除术后使用双8F超细胸管引流可改善疼痛控制并减少特定并发症：一项回顾性多中心队列研究
• 一例罕见的前列腺腺泡腺癌和原发性前列腺尿路上皮癌并发病例：病例报告和文献综述
• 妊娠早期（<20周）甘油三酯-葡萄糖指数与妊娠并发症及不良妊娠结局的相关性：一项系统综述和荟萃分析