机械除栓导管治疗下肢动脉硬化闭塞症支架内再狭窄应用的临床研究  

Clinical study of mechanical thrombectomy in treating in-stent restenosis of lower extremity arteriosclerosis obliterans

作　　者：张艳[1] 林洋[2] 李承志[1] 张红[1] 贺海朋[1] 周咪咪 师贞爱 王晓白[1] 

机构地区：[1]暨南大学附属第一医院介入与血管外科,广州510632 [2]喀什地区第一人民医院肝胆外科

出　　处：《中华放射学杂志》2017年第9期699-703,共5页Chinese Journal of Radiology

基　　金：广东省省级科技计划项目（2014A020209038）

摘　　要：目的 探讨机械除栓导管治疗下肢动脉硬化闭塞症,支架内再狭窄的安全性及疗效.方法 9例下肢动脉硬化闭塞支架植入后（3例为覆膜支架）支架内再狭窄的患者,男7例、女2例,年龄66.0～84.0岁,平均（75.4±6.3）岁.术后下肢缺血症状复发在术后6.0～120.0个月,中位复发时间28.8个月,均行择期再次腔内治疗.再次治疗采用Rotarex机械除栓术,必要时球囊扩张术和支架植入术,术后常规抗血小板治疗,定期彩色超声复查随访.结果 9例支架内再狭窄患者下肢动脉再通成功,其中6例同时行球囊扩张、1例行支架植入.患者术前平均ABI为0.29±0.07,术后为0.88±0.07,差异有统计学意义（t=28.875,P〈0.05）.住院期间无并发症发生,随访3.0～18.0个月,中位随访时间11.5个月,9例患者全部存活,下肢缺血症状无复发.结论 使用Rotarex机械除栓导管,治疗下肢动脉硬化闭塞症支架内再狭窄可以有效减容,是一种安全有效的腔内治疗方法.Objective To evaluate the safety and efficacy of mechanical thrombectomy in treating in-stent restenosis of lower extremity arteriosclerosis obliterans. Methods From May 2015 to Sep 2016, the clinical data of 9 cases of lower extremity arteriosclerosis obliterans who were with in-stent restenosis（3 were stent graft）were retrospectively collected, and of which 7 were males and 2 were females with a mean age of （75.4 ± 6.3）years old. All the cases were treated by mechanical thrombectomy of Rotarex catheter. All the patients were diagnosed via low-extremity artery CTA, and treated by means of the Rotarex catheter, combined with angioplasty and stent if necessary. All patients received antiplatelet therapy. Doppler ultrasonography was taken during the followed-up. Results All the 9 cases were successed in technology, without complications in hospital. All patients received Rotarex mechanical thrombectomy. Six of which used balloon and 1 stent implanted. The ABI increased from 0.29 ± 0.07 to 0.88 ± 0.07 after treatment, the difference was statistically significant（t=28.875,P＆lt;0.05）. All the patients were followed up for 3—18 （median time, 11.5）months. No death and symptoms recurrence appeared during the follow-up. Conclusions Mechanical thrombectomy using Rotarex catheter is a safe and effective treatment for in-stent restenosis in lower extremity arterial diseases.

关 键 词：动脉硬化 闭塞性 下肢 放射学 介入性 支架内再狭窄 机械除栓术 

分 类 号：R543.5[医药卫生—心血管疾病]