椎动脉起始段狭窄支架置入术后再狭窄危险因素的分析  

Risk factors analysis for restenosis after vertebral artery origin stenting

作　　者：马妍[1] 宋刚[1] 王旭[1] 李龙[1] 程磊[1] 任小鲁 王亚冰[1] 谌燕飞[1] 华扬[2] 焦力群[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]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》2015年第7期337-341,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家"十二五"科技支撑计划项目(2011BAI08B04)

摘　　要：目的探讨椎动脉起始段支架置入术后再狭窄发生的危险因素。方法回顾性分析2006年1月至2012年12月在首都医科大学宣武医院神经外科收治的椎动脉起始段狭窄患者共775例,经DSA确诊为椎动脉起始段重度狭窄,支架置入治疗后超声随访1~106个月,中位数12个月。根据支架内是否发生再狭窄（狭窄率≥50%）,将患者分为再狭窄组234例和未再狭窄组541例,并行单因素分析,再进行多因素COX分析,分析导致再狭窄的危险因素。结果 （1）775例患者中,手术成功率和技术成功率分别为99.87%（774例）和99.48%（771例）。围手术期内,2例（0.26%）术后脑出血,其中1例（0.13%）死亡;4例（0.52%）术后出现脑梗死症状,失访117例。术后支架内再狭窄共发生234例,再狭窄发生率为35.89%（234/652）。187例（79.91%）再狭窄发生在术后12个月内。（2）多因素分析显示术后血管直径越小,越容易导致术后再狭窄的发生（P〈0.01）;药物洗脱支架与金属裸支架相比,再狭窄风险显著降低（HR=0.532,95%CI：0.397~0.713,P〈0.01）结论术后血管直径越小越容易导致术后再狭窄,药物洗脱支架能有效预防支架置入术后再狭窄。Objective To investigate the in-stent restenosis after vertebral artery ostium stenting（ VAOS）,and to determine the risk factors for in-stent restenosis. Methods Respective analysis of clinical data of 775 cases received VAOS in Xuan Wu Hospital of Capital Medical University from Jan. 2006 to Dec. 2012. Severe stenosis of vertebral artery ostium were diagnosed by DSA,and followed-up by ultrasound. The risk factors were assessed by COX analysis for in-stent restenosis ≥ 5 0 %. Results This study included 7 7 5 patients. Surgical success rate was 99. 87%（ n = 774）,technique success rate was 99. 48%（ n = 771）. Two patients had cerebral hemorrhage after operation,one of them was dead. Four patients had cerebral infarction. The mean follow-up period was 12 months. The restenosis rate was 35. 89%（ 234 /652）.79. 91% of restenosis occurred within 12 months after operation. COX analysis showed the vessels diameter after stenting was the independent predictors of in-stent restenosis（ P 0. 01）. The in-stent restenosis rate of drug-eluting stents was lower than metal-bare stents（ HR 0. 532,95% CI 0. 397-0. 713,P 0. 01）.Conclusion The in-stent restenosis was peculiarly prone to the smaller vessels diameter after VAOS. Drug-eluting stents were superior to metal-bare stents in preventing in-stent restenosis.

关 键 词：椎动脉狭窄 支架置入术 再狭窄 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]