血管结构对椎动脉支架术后再狭窄的影响研究  

Impact of vascular structure on in-sent restenosis after vertebral artery stenting

作　　者：李景植[1] 华扬[1] 刘然[1] 田晓洁 焦力群[2] Li Jingzhi;Hua Yang;Liu Ran;Tian Xiaojie;Jiao Liqun(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2019年第11期574-580,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81070924);北京市医院管理局青年人才培养“青苗”计划(QML20150803)

摘　　要：目的探讨血管结构对椎动脉起始段狭窄(VAOS)支架术后再狭窄的影响因素。方法回顾性连续纳入2013年1月至2014年12月首都医科大学宣武医院神经外科椎动脉起始段重度狭窄行支架置入术的患者325例,均经彩色多普勒超声(CDUS)检查诊断,并经DSA证实椎动脉起始段重度狭窄(狭窄率≥70%)。根据是否发生支架内再狭窄(ISR),将325例患者分为ISR组(116例)和无ISR组(209例)。通过CDUS对支架治疗后患者进行定期随访,记录目标椎动脉的血管结构特征及临床相关信息。以Kaplan-Meier方法计算ISR的累积发生率,绘制生存曲线,并用Log-rank法(χ^2检验或Fisher确切概率法)比较生存曲线的差异。采用Cox比例风险回归模型对可能的影响因素进行多因素分析。结果(1)325例患者中位随访时间为14(6,38)个月。两组椎动脉起始段重度狭窄行支架置入术患者年龄、性别、重度狭窄侧别、糖尿病、高血压病、吸烟史、后循环症状、后循环脑梗死的组间差异均无统计学意义(均P>0.05)。(2)ISR组和无ISR组支架类型[药物洗脱支架(DES)/金属祼支架(BMS)]的差异有统计学意义(48/68比125/84,χ^2=10.18,P=0.001);ISR组支架内径大于无ISR组,组间差异有统计学意义[(4.5±0.7)mm比(4.3±0.8)mm,t=-2.52,P=0.010];两组使用支架长度的差异无统计学意义(P>0.05)。(3)ISR组存在椎动脉血管走行弯曲者比例大于无ISR组[42.2%(49/116)比26.8%(56/209),χ^2=8.14],支架置入术前椎动脉原始内径大于无ISR组[(3.5±0.6)mm比(3.3±0.5)mm,t=-2.74],组间差异均有统计学意义(均P<0.05);余椎动脉结构特征的组间差异均无统计学意义(均P>0.05)。(4)进一步行多因素Cox逐步回归分析,结果显示,使用DES(HR=0.58,95%CI:0.39~0.86,P=0.01)及目标椎动脉走行弯曲(HR=1.52,95%CI:1.02~2.28,P=0.04)是VAOS支架术后发生ISR的危险因素;术后血管内径与术前原始内径之比与发生ISR无明显相关性(P>0.05)。(5)对血管走行弯�Objective To investigate the influencing factors of in-stent restenosis(ISR)following stenting for vertebral artery ostium stenosis(VAOS).Methods From January 2013 to December 2014,a total of 325 patients receiving stenting for severe vertebral artery stenosis(≥70%),which was diagnosed with color Doppler ultrasonography(CDUS)and confirmed by digital subtraction angiography(DSA)were retrospectively recruited.All patients were divided into the ISR group(116 cases)and the non-ISR group(209 cases).CDUS was utilized for periodical follow-up after the procedure.All vascular structure characteristics and related clinical information of the target vertebral artery were recorded.The Kaplan-Meier was used to calculate the accumulative ISR incidence and generate the survival curves.The Log-rank test(χ^2 test or Fisher exact test)was used to compare the discrepancy in survival curves.Cox proportional risk regression model was used to analyze the possible influencing factors.Results(1)All patients were followed up for a median of 14(6,38)months.There was no significant difference between the two groups in age,gender,side of severe stenosis,diabetes mellitus,hypertension,smoking history,symptoms of posterior circulation and posterior circulation cerebral infarction(all P>0.05).(2)There was significant difference in stent type using of drug eluting stent(DES)or bare metal stent(BMS)between the two groups(48/68 vs.125/84,χ^2=10.18,P=0.001).The stent diameter in the ISR group was significantly larger than that in the non-ISR group([4.5±0.7]mm vs.[4.3±0.8]mm,t=-2.52,P=0.010).There was no significant difference in stent length between the two groups(P>0.05).(3)Compared with the non-ISR group,the ISR group had more prevalent tortuosity of vertebral artery(42.2%[49/116]vs.26.8%[56/209],χ^2=8.14)and larger original diameter of the vertebral artery before stenting([3.5±0.6]mm vs.[3.3±0.5]mm,t=-2.74).The differences were significantly(P<0.05).There was no significant difference in other structural characteristics of vertebral a

关 键 词：椎动脉供血不足 支架置入术 超声检查 多普勒 彩色 支架内再狭窄 

分 类 号：R54[医药卫生—心血管疾病]