超声检测椎动脉支架置入后再狭窄及其影响因素的分析  

Vascular ultrasound analysis of restenosis after vertebral artery stenting and its influencing factors

作　　者：华扬[1] 李景植[1] 贾凌云[1] 刘蓓蓓[1] 段春[1] 王力力[1] 

机构地区：[1]首都医科大学宣武医院血管超声科,北京100053

出　　处：《中国脑血管病杂志》2012年第11期569-572,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81070924)

摘　　要：目的通过彩色多普勒超声评估残余狭窄、支架类型、降脂类药物等因素对椎动脉起始段支架置入术(VAOS)后再狭窄发生率的影响。方法前瞻性纳入2009年1月—2011年9月,因椎动脉起始段粥样硬化性狭窄行支架置入术的患者共177例(192枚支架),15例为双侧椎动脉起始段置入支架。采用彩色多普勒血流显像(CDFI)检测支架置入术前、术后1年患侧椎动脉的管径和血流动力学参数,判断1年的再狭窄发生率。分析椎动脉支架置入后再狭窄发生率的相关因素。结果①术后1周残余狭窄的检出率为22.4%(43/192)。术后1年的再狭窄发生率为42.7%(82/192)。②术后残余狭窄者再狭窄发生率为76.7%(33/43),明显高于无残余狭窄患者的32.9%(49/149),差异有统计学意义(P=0.000)。药物涂层支架再狭窄的发生率明显低于裸支架(30.3%比49.2%),差异有统计学意义(P=0.012)。③服用降脂类药物者再狭窄发生率低于未服用者(46.7%比65.2%,P=0.047),其中高脂血症患者术后服用他汀类降脂药者VAOS的再狭窄发生率低于未服用者(41.7%比77.8%),差异有统计学意义(P=0.019)。结论 VAOS后1年的再狭窄率较高,术后残余狭窄是再狭窄的危险因素,药物涂层支架及术后规律性降脂类药物的应用,可有效降低支架内再狭窄的发生率。Objective To evaluate the influence of residual stenosis, stent type and lipid-lowering drugs （statins） on the incidence of in-stent restenosis after vertebral artery origin stenting （VAOS） with color Doppler flow imaging （CDFI）. Methods A total of 177 inpatients （ 192 stents） whom underwent stenting for vertebral artery origin atherosclerotic stenosis from January 2009 to September 2011 were en- rolled prospectively. Fifteen of them were treated with bilateral VAOS, the residual diameter （Ds） , original diameter （Dr）, peak systolic velocity （PSV）, and end diastolic velocity （EDV） on the ipsilateral verte- bral artery origin before and one year after the procedure were measured using CDFI. The incidence of in-stent restenosis was identified at 1 year after stenting. The relevant factors of in-stent restenosis after vertebral artery stenting were analysed. Results ①The rate of residual stenosis at 1 week after procedure was 22. 4% （43/192）. The incidence of instent restenosis at 1 year after procedure was 42.7% （ 82/192）. ②The incidence of instent restenosis in patients with residual stenosis after procedure was significantly higher than that in those without residual stenosis （76.7% [ 33/43 ] vs. 32.9% [ 49/149 ]. P = 0. 000）. The incidence of restenosis of drug-eluting stents was significantly lower than that of the bare metal stents （30.3% vs. 49.2% ） （P = 0. 012）.③The VAOS patients who had took statins after procedure the incidence of in - stent restenosis was lower than those who had not took statins （46.7 % vs. 65.2 % , P = 0. 047 ）. Among the patients with hyperlipidemia who had took statins lipid-lowering drugs after procedure, the incidence of instent restenosis of VAOS was significantly lower than those had took statins （41.7% vs. 77.8% ）. Conclusion The incidence of instent restenosis at 1 year after VAOS was high. The postoperative residual stenosis was an independent risk factor for restenosis. Drugeluting stents and using lipid-lowerin

关 键 词：椎动脉狭窄 支架 超声检查 多普勒 彩色 支架内再狭窄 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]