病变长度对颅内动脉支架成形术后再狭窄的影响  

Effect of lesion length on in-stent restenosis after intracranial stenting

作　　者：朱双根[1] 朱幼玲 周志明[1] 刘文华[1] 殷勤[1] 马敏敏[1] 樊小兵[1] 徐格林[1] 刘新峰[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院神经内科,210002 [2]安徽医科大学第三附属医院神经内科

出　　处：《中华医学杂志》2010年第29期2040-2043,共4页National Medical Journal of China

基　　金：基金项目：南京军区“十一五”重点课题（082026）

摘　　要：目的 评价病变长度对颅内动脉支架成形术后再狭窄的影响.方法 选取2004年3月至2009年9月成功实施球扩金属裸支架置入术治疗症状性颅内动脉粥样硬化性狭窄的住院患者65例,所有患者均行脑血管造影复查.按病变长度分为3组：短病变组（＜5 mm）,中等长度病变组（5～10 mm）和长病变组（＞10 mm）.支架内再狭窄定义为管腔狭窄＞50%或者管腔直径绝对值减少超过20%.分析不同病变长度对再狭窄的影响,并采用多元Cox回归逐步筛选出预测支架内再狭窄的独立风险因素.结果 短病变组、中等长度病变组和长病变组各组病例数分别为28例、29例和8例.血管造影随访中位数时间为7个月（5～30个月）,有19例发生再狭窄（29.2%）.3组再狭窄率依次为：14.3%、37.9%和50%（P=0.045）.Cox回归多因素分析显示病变长度[风险比（HR）=1.210,95%可信区间（CI）=1.011～1.446,P=0.037]和糖尿病（HR=2.630,95%CI=1.032～6.705,P=0.043）与再狭窄有关.结论 病变长度和糖尿病是颅内动脉支架成形术后再狭窄的独立风险因素.Objective To evaluate the effect of lesion length on in-stent restenosis （ISR） after intracranial stenting. Methods Between March 2004 and September 2009, 65 patients with symptomatic intracranial arterial stenosis were successfully implanted with single bare metal balloon-mounted stent. All received a conventional angiographic follow-up. The patients were divided into three groups according to lesion length： short lesions （ 〈5 mm）, medium lesions （5-10 mm） and long lesions （ 〉10 mm）. ISR was defined as 〉 50% stenosis within stent or absolute luminal loss 〉 20%. The influence of different lesion lengths on ISR was evaluated. Furthermore, the independent predictive factors for ISR were selected. Results There were short lesions （ n = 28 ）, medium lesions （ n = 29 ） and long lesions （ n = 8 ）. The median interval of angiographic follow-up was 7 months with a range of 5-30 months. Of 65 patients, 19 （29.2%） had ISR. The ISR rates were 14.3%, 37.9% and 50% in short lesions, medium lesions and long lesions respectively （ P = 0. 045 ）. Multivariate Cox regression analysis showed that lesion length （ HR = 1.210; 95% CI= 1.011-1.446; P =0.037） and diabetes （HR=2.630; 95% CI= 1.032-6.705; P= 0. 043） were associated with ISR. Conclusion Lesion length and diabetes are two independent predictors for ISR after intracranial stenting.

关 键 词：颅内动脉 动脉粥样硬化 支架成形术 再狭窄 血管造影 

分 类 号：R743[医药卫生—神经病学与精神病学]