椎动脉支架置入术的临床长期随访  

Long-term clinical follow-up outcome of patients after vertebral artery stenting

作　　者：周峰[1] 马黎[1] 傅国萍[1] 鲁国建[1] 赖春梅[1] 董芬[1] 金国兴[1] 周阳[1] 刘荣荣 Zhou Feng;Ma Li;Fu Guoping;Lu Guojian;Lai Chunmei;Dong Fen;Jin Guoxing;Zhou Yang;Liu Rongrong(Department of Neurology, Shaoxing No. 2 Hospital, Shaoxing 312000, Zhej iang Province, China)

机构地区：[1]绍兴第二医院神经内科,312000

出　　处：《中华老年心脑血管病杂志》2018年第5期517-521,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：2016年浙江绍兴柯桥区医疗卫生自筹经费科技计划(2016KZ007)

摘　　要：目的本研究对椎动脉支架置入术患者进行>1年的随访,探讨支架内再狭窄(in-stent restenosis,ISR)和临床事件发生情况及危险因素。方法选择2010年1月~2016年10月在绍兴第二医院神经内科接受数字减影血管造影术检查的椎动脉支架置入术患者46例(48枚支架)。根据支架内是否再狭窄分为ISR组8例和无ISR组38例;又根据临床事件发生情况分为临床事件组8例和无临床事件组38例,分析支架置入术患者长期预后的影响因素。结果 46例患者中,术前血管狭窄程度(80.7±14.2)%,残余血管狭窄程度(3.0±8.4)%,术前血管狭窄长度(7.7±4.6)mm,术后血管造影平均随访时间(31.6±20.8)个月,ISR 8例(17.4%),而临床平均随访时间(53.8±27.0)个月,有8例(17.4%)患者出现临床事件。生存分析显示,ISR主要出现在最初20个月;同时在87个月时有50.0%患者未发生临床事件。ISR组再狭窄长度明显高于无ISR组,差异有统计学意义[(6.00±2.00)mmvs(2.76±4.14)mm,P=0.003]。临床事件组支架直径明显小于无临床事件组,差异有统计学意义[(3.53±0.93)mmvs(4.18±0.67)mm,P=0.024]。结论椎动脉支架置入术患者长期预后可能受到再狭窄长度和支架直径的影响。Objective To study the clinical events and risk factors of in stent restenosis（ISR）during the1 year follow-up period after vertebral artery stenting.Methods Forty-six patients with48 stents implanted from the Shaoxing No.2 Hospital between January 2010 and October 2016 were divided into ISR group（n=8）and ISR-free group（n=38）or clinical events group（n=8）and clinical events-free group（n=38）.The influencing factors for their long-term clinical outcome were analyzed after vertebral artery stenting.Results The mean stenosis length was（7.7±4.6 mm,the stenosis severity was 80.7%±14.2%,and the residual stenosis was 3.0%±8.4% before stenting.The mean angiographic follow-up time was 31.6±20.8 months,during which ISR occurred in 8 patients（17.4%）.The mean clinical follow-up time was 53.8±27.0 months,during which clinical events occurred in 8 patients（17.4%）.Survival analysis showed that ISR usually occurred in the first 20 months and no clinical events occurred in 23 patiemts（50.0%）after vertebral artery stenting.The stenosis was significantly longer in ISR group than in ISR-free group（6.00±2.00 mmvs 2.76±4.14 mm,P=0.003）.The diameter of stents was significantly shorter in clinical events group than in clinical events-free group（3.53±0.93 mmvs4.18±0.67 mm,P=0.024）.Conclusion The long-term clinical follow-up outcome is associated with the length and diameter of stents in patients after vertebral artery stenting.

关 键 词：椎动脉 支架 血管造影术 数字减影 脑缺血发作 短暂性 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]