颅内前循环wingspan支架内再狭窄的危险因素分析  

Risk factors for in-stent restenosis after wingspan stenting in patients with atherosclerotic anterior circulation stenosis

作　　者：王冰 陈虎 李江 邓剑平 何宜轩 赵振伟 WANG Bing;CHEN Hu;LI Jiang;DENG Jian-ping;HE Yi-xuan;ZHAO Zhen-wei(Department of Neurosurgery,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院神经外科,西安710038

出　　处：《中国临床神经外科杂志》2021年第6期419-421,425,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅内前循环动脉粥样硬化性狭窄wingspan支架置入术后支架内再狭窄(ISR)的危险因素。方法回顾性分析2011年1月至2019年6月winspan支架置入术治疗的99例颅内前循环动脉粥样硬化性狭窄的临床资料。出院后6~12个月复查DSA,ISR定义为:支架附近(5 mm内)狭窄程度超过50%;初始治疗后残留狭窄程度在30%~50%的病例中,绝对管腔直径减少20%。结果99例共置入wingspan支架100枚,支架成功置入成功率为100%。术后随访6~72个月,中位随访时间12个月(四分位数区间8~19.5个月)。29处(29.0%)发生ISR,71处未发生ISR。多因素logistic回归分析结果显示高血压病史、残留狭窄程度>20%、血脂异常是ISR的独立危险因素(P<0.05)。结论对于颅内前循环动脉粥样硬化性狭窄病人,支架置入术中注意控制残余狭窄程度,术后应严格控制血脂;对于合并高血压病史的病人,更加要注意危险因素的控制,术后需更为密切的随访和针对性的强化药物治疗。Objective To analyze the risk factors for in-stent restenosis(ISR)after wingspan stenting in the patients with atherosclerotic anterior circulation stenosis.Methods A retrospective analysis was performed on 99 patients with atherosclerotic anterior circulation stenosis who underwent wingspan stenting from January 2011 to June 2019.Re-examination of DSA was performed 6 to 12 months after discharge.ISR was defined as:the degree of stenosis near the stent(within 5 mm)>50%;the absolute lumen diameter was reduced by 20%in the patients with residual stenosis of 30%~50%after initial treatment.Results A total of 100 stents were placed in these 99 patients,and the surgical success rate was 100%.The postoperative follow-up ranged from 6 months to 72 months,with a median time of 12 months(interquartile range,8~19.5 months).ISR occurred in 29 stents(29.0%),and no ISR in 71 stents.Multivariate logistic regression analysis showed that a history of hypertension,the degree of residual stenosis>20%,and dyslipidemia were independent risk factors for ISR(P<0.05).Conclusions For patients with atherosclerotic anterior circulation stenosis,the degree of residual stenosis should be strictly controlled during the stent placement,and the level of blood lipids should be strictly controlled after the surgery.For patients with a history of hypertension,more attention should be paid to the control of risk factors and more close followup and targeted intensive drug treatment are needed.

关 键 词：缺血性脑卒中 颅内动脉狭窄 动脉粥样硬化性狭窄 支架置入术 wingspan支架 支架内再狭窄 危险因素 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]