弓上颅外动脉支架置入术后再狭窄危险因素研究  

Risk Factors Study on In-stent Restenosis after Stent Implantation for Extracranial Arteries above Aortic Arch

作　　者：田鸿福 张克忠[2] TIAN Hong-fu;ZHANG Ke-zhong(Nanjing Medical University,Nanjing,211166,China;The First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学,南京211166 [2]南京医科大学第一附属医院神经内科,南京210029

出　　处：《中国临床神经科学》2020年第3期273-280,共8页Chinese Journal of Clinical Neurosciences

摘　　要：目的弓上动脉支架置入术已经成为治疗头颈部动脉重度狭窄的主要方法,本研究探讨弓上动脉支架置入术后支架内再狭窄的独立危险因素以及不同血管支架内再狭窄率的不同原因。方法回顾性分析2017年10月至2019年3月行弓上动脉支架置入术219例患者的临床资料。术后复查头颈部CTA或全脑血管造影术(DSA)判定有无支架内再狭窄,依据是否存在支架内狭窄分为再狭窄组与非狭窄组,对比分析两组的术前基线资料和术后临床数据。采用多因素Logistic回归分析支架内再狭窄的独立危险因素。结果219例患者置入支架共计265枚:颈动脉127枚、椎动脉138枚。随访(15.2±4.5)个月,265枚支架中,颈动脉出现再狭窄8/127枚(6.3%),椎动脉出现再狭窄24/138枚(17.4%)。多因素Logistic回归分析发现病变血管直径(OR=1.738,95%CI:1.294~2.336,P<0.001),吸烟史(OR=3.575,95%CI:1.042~12.258,P=0.043),糖尿病史(OR=2.561,95%CI:1.474~4.448,P=0.001),残余狭窄(OR=1.225,95%CI:1.081~1.390,P=0.002)是不同部位动脉支架置入术后支架内再狭窄的独立危险因素。结论颈动脉支架置入术后再狭窄率较椎动脉低,血管直径与支架术后再狭窄呈负相关关系,且是引起不同血管再狭窄率不同的原因,应用药物洗脱支架治疗椎动脉狭窄是减少支架置入术后再狭窄的有效方法。Aim Stenting for extracranial arteries above aortic arch has become an important method of treatment for the carotid artery and vertebral artery with severe stenosis.The reason for caused difference of in-stent restenosis(ISR)rate and the risk factors of restenosis were analyzed.Methods A total of 265 stents implantation(219 patients)were retrospectively analyzed,including 127 carotid stents and 138 vertebral stents from October 2017 to March 2019.The presence or absence of stent restenosis was predicated by using cranio-cervical computed tomographic angiography(CTA)or digital subtraction angiography(DSA),they were divided into a ISR group and a non-stenosis group,and the clinical data of the two groups were compared and analyzed.Independent risk factors for instent restenosis were analyzed by multivariate Logistic regression.Results Of the 265 stents,8(6.3%)carotid arteries and 24(17.4%)vertebral arteries suffered from ISR during a(15.2±4.5)month follow-up.Multivariate regression analysis revealed that the vessel diameter(OR=1.738,95%CI:1.294-2.336,P<0.001,smoking(OR=3.575,95%CI:1.042-12.258,P=0.043),diabetes(OR=2.561,95%CI:1.474-4.448,P=0.001),residual stenosis(OR=1.225,95%CI:1.081-1.390,P=0.002)were the independent risk factors of ISR in different parts of the artery after stenting.Conclusion The ISR rate of carotid artery stenting was lower than that of vertebral artery stenting,and the vascular diameter was negatively correlated with ISR.The drug-eluting stents could be an effective method to reduce ISR after implantation in the treatment of vertebral artery stenosis.

关 键 词：弓上颅外动脉 支架置入术后 支架内再狭窄 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]