cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-38-4-70-76cardiotomsk-2053Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESОптимальный режим двойной антиагрегантной терапии у пациентов с хронической ишемической болезнью сердца (обзор литературы)Optimal time of dual antiplatelet therapy in patients with coronary heart disease (literature review)https://orcid.org/0000-0002-1011-3397ГоргулькоА. П.GorgulkoA. P.

Горгулько Александр Павлович, аспирант, врач по рентгенэндоваскулярным диагностике и лечению

630055, Новосибирск, ул. Речкуновская, 15

Alexander P. Gorgulko, Graduate Student, Doctor of X-ray Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055

alexandergorgulko@gmail.comhttps://orcid.org/0000-0002-2320-2233БарановА. А.BaranovA. A.

Баранов Алексей Алексеевич, аспирант, врач по рентгенэндоваскулярным диагностике и лечению

630055, Новосибирск, ул. Речкуновская, 15

Alexey A. Baranov, Graduate Student, Doctor of X-ray Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055

ivrach@icloud.comhttps://orcid.org/0000-0001-5419-913XХелимскийД. А.KhelimskiiD. A.

Хелимский Дмитрий Александрович, канд. мед. наук, врач по рентгенэндоваскулярным диагностике и лечению

630055, Новосибирск, ул. Речкуновская, 15

Dmitriy A. Khelimskii, Cand. Sci. (Med.), Doctor of X-ray Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055

dkhelim@mail.ruhttps://orcid.org/0000-0001-5214-8996КрестьяниновО. В.KrestyaninovO. V.

Крестьянинов Олег Викторович, д-р мед. наук, руководитель центра эндоваскулярной хирургии, врач по рентгенэндоваскулярным диагностике и лечению

630055, Новосибирск, ул. Речкуновская, 15

Oleg V. Krestyaninov, Dr. Sci. (Med.), Head of the Center for Endovascular Surgery, Doctor of X-ray Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055

o_krestyaninov@meshalkin.ruhttps://orcid.org/0000-0003-4480-2585БадоянА. Г.BadoyanA. G.

Бадоян Арам Гозоевич, канд. мед. наук, врач по рентгенэндоваскулярной диагностике и лечению

630055, Новосибирск, ул. Речкуновская, 15

Aram G. Badoyan. Cand. Sci. (Med.), Doctor of X-ray Endovascular Diagnostics and Treatment

15, Rechkunovskaya str., Novosibirsk, 630055

soir007@yandex.ruНациональный медицинский исследовательский центр имени академика Е.Н. Мешалкина Министерства здравоохранения Российской ФедерацииРоссияE. Meshalkin National Medical Research Center of the Ministry of Health of the Russian FederationRussian Federation2023120120243847076Copyright © Горгулько А.П., Баранов А.А., Хелимский Д.А., Крестьянинов О.В., Бадоян А.Г., 20242024Горгулько А.П., Баранов А.А., Хелимский Д.А., Крестьянинов О.В., Бадоян А.Г.Gorgulko A.P., Baranov A.A., Khelimskii D.A., Krestyaninov O.V., Badoyan A.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2053

В настоящее время пациентам, которым было выполнено чрескожное коронарное вмешательство (ЧКВ) со стентированием, рекомендован прием двойной антиагрегантной терапии (ДААТ) с целью профилактики тромбоза имплантируемого стента и потенциальных ишемических событий в отдаленном периоде. Однако выбор оптимальных сроков ДААТ после ЧКВ – это до сих пор сложная и актуальная проблема для лечащего врача. Увеличение продолжительности ДААТ после ЧКВ коррелирует с более низкой частотой ишемических событий. В то же время при более длительном режиме ДААТ имеет место более значительное увеличение рисков послеоперационных кровотечений. Исходя из этого, важно найти баланс между потенциальными рисками кровотечений и ожидаемой пользой в снижении ишемических событий, при этом учитывая индивидуальные клинические особенности каждого пациента. Методы внутрисосудистой визуализации, а именно внутрисосудистая когерентная томография, позволяют получить высокоинформативную прижизненную морфологическую оценку состояния коронарных артерий, степень формирования неоинтимы и мальпозицию имплантированного стента, что, в свою очередь, может помочь в выборе оптимальных сроков ДААТ и профилактике нежелательных побочных событий.

However, the choice of optimal time of DAPT after PCI is still a difficult and urgent problem for the attending physician. An increase in DAPT duration after PCI correlates with a lower frequency of ischemic events. At the same time, with a longer DAPT regime, there is a more significant increase in the risks of postoperative bleeding. Hence, it is important to find a balance between the potential risks of bleeding and the expected benefits in reducing ischemic events, while taking into account the individual clinical characteristics of each patient. Intravascular imaging methods, such as intravascular coherence tomography, allow obtaining a highly informative lifetime morphological assessment of the coronary arteries, the formation of the neointima and the malposition of the implanted stent, which, in turn, can help in choosing the optimal timing of the DAPT and prevention of undesirable side events.

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The authors declare that there are no conflicts of interest present.