椎动脉狭窄血管成形术后再狭窄因素及处理  

Cause Analysis and Treatment of Vertebral Artery Stenosis Angioplasty Restenosis

作　　者：蔡学礼[1,2] 高峰[1] 

机构地区：[1]浙江大学医学院附属第二医院神经内科,310006 [2]温州医学院附属第五医院(丽水市中心医院神经内科)

出　　处：《临床放射学杂志》2013年第9期1327-1331,共5页Journal of Clinical Radiology

基　　金：浙江省科技厅资助项目(编号:2012C33117)

摘　　要：目的探讨椎动脉(VA)狭窄患者支架置入术后再狭窄因素及处理方法。方法 70例症状性VA狭窄患者行支架置入术,以彩色多普勒超声(CDI)、CT血管造影(CTA)、数字减影血管造影(DSA)随访支架置入术后的再狭窄率。选择脑血管病危险因素、靶病变长度、残余狭窄、支架位置、钙化斑块等14项观察指标,分析上述各种临床因素与再狭窄的相关性。结果 70例患者置入支架80枚,平均随访时间为(12.5±5.4)个月,CDI随访70例,CTA随访35例,DSA随访23例,14例(14/70,20%)发生再狭窄。术后低密度脂蛋白>2.1 mmol/l、术前狭窄>90%、残余狭窄>20%、椎动脉原始管径<3 mm、狭窄段长度>10 mm及合并钙化、支架突出在锁骨下动脉<1mm与再狭窄显著相关(P<0.05)。年龄>65岁、男性、吸烟史、饮酒史、高血压、糖尿病、冠心病史与支架内再狭窄无关(P>0.05)。3例症状性再狭窄患者行球囊扩张术,效果良好。结论术后低密度脂蛋白>2.1 mmol/l、术前狭窄>90%、残余狭窄>20%、椎动脉原始管径<3 mm、狭窄段长度>10 mm、合并钙化及支架突出在锁骨下动脉<1 mm可能是再狭窄相关因素,出现症状性再狭窄能有效处理。Objective To investigate factors and treatment of the vertebral artery （VA） stenosis stent restenosis. Methods 70 cases of symptomatic VA stenosis received stent implantation, stent restenosis rate was evaluated by color Doppler ultrasound （CDI） , CT angiography （CTA） , digital subtraction angiography （DSA）. Cerebrovascular disease risk factors, the length of the target lesion, residual stenosis, stent position, calcified plaque were observed, and the correlation of the various clinical factors and restenosis were analyzed. Results 70 patients with 80 stents, and the average follow up time was （12.5 ± 5.4） months, CDI follow up of 70 cases, CTA follow up of 35 cases, DSA follow up of 23 cases, 14 cases （ 14/70, 20% ） occurred restenosis. The following factors were associated with restenosis （ P 〈 0. 05 ） ： the postoperative hypodensity lipoprotein greater than 2.1 mmol/1, the preoperative stenosis lumen more than 90% , residual stenosis lumen more than 20% , the original diameter of vertebral artery less than 3 mm, narrow length more than 10 mm and merge calcification, stent prominent in the subclavian artery was less than 1 mm. Age 〉 65 years old, male, smoking history, history of alcohol consumption, high blood pressure, diabetes, a history of coronary heart disease were unrelated （P 〉 0.05 ）. Three cases of symptomatic restenosis underwent balloon angioplasty with good effect. Conclusion Postoperative LDL greater than 2.1 mmol / 1, the preoperative stenosis greater than 90% , residual stenosis greater than 20% , the original vertebral artery diameter less than 3 mm, narrow section of length greater than 10 ram, calcified plaque and stent prominent in the subclavian artery less than 1 mm might be relevant factors, symptomatic patients can be effectively treated with restenosis.

关 键 词：椎动脉 支架 再狭窄 因素分析及处理 

分 类 号：R743.3[医药卫生—神经病学与精神病学]