椎动脉起始部狭窄患者行球囊预扩张对选择支架型号的影响  

Effect of balloon pre-dilatation on the selection of stent size in patients with vertebral artery ostium stenosis

作　　者：徐程华 胡兴越 王志敏[3] XU Chenghua;HU Xingyue;WANG Zhimin(Department of Neurology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;不详)

机构地区：[1]浙江大学医学院附属邵逸夫医院神经内科,杭州310016 [2]浙江大学医学院 [3]台州市第一人民医院神经内科 [4]不详

出　　处：《浙江医学》2022年第5期470-473,共4页Zhejiang Medical Journal

摘　　要：目的探究球囊预扩张在椎动脉起始部狭窄患者选择支架型号的影响。方法选择2017年1月至2020年12月在台州市第一人民医院行椎动脉起始部支架植入术患者69例。测量并比较球囊预扩张前椎动脉起始部狭窄远端血管直径(预扩张前直径)和球囊预扩张后椎动脉起始部狭窄远端血管直径(预扩张后直径),根据预扩张前直径和预扩张后直径是否发生变化,将患者分为直径变化组和直径无变化组,对比两组一般资料。根据预扩张前直径选择的支架型号为预扩张前支架型号,预扩张后直径选择的支架型号为预扩张后支架型号。根据预扩张前、后支架型号是否不同,分为支架型号变化组和支架型号无变化组。对比两组一般资料及预扩张前直径<4 mm患者占比的差异。测量球囊预扩张前椎动脉起始部狭窄率并分为椎动脉起始部狭窄率50%~<80%和椎动脉起始部狭窄率80%~99%两组,对比两组支架型号变化患者占比和测量直径变化患者占比的差异。采用logistic回归分析选择支架型号的影响因素。结果患者预扩张后直径为(4.35±0.79)mm大于预扩张前直径(4.19±0.82)mm,差异有统计学意义(t=-9.16,P<0.01)。支架型号变化组预扩张前直径<4 mm患者占比多于支架型号无变化组,差异有统计学意义(P<0.01)。80%~99%组支架型号变化患者占比>50%~<80%组,差异有统计学意义(P<0.05)。回归分析提示,球囊预扩张前椎动脉起始部狭窄远端血管直径<4 mm和椎动脉起始部狭窄率80%~99%是支架型号变化的危险因素(均P<0.05)。结论球囊预扩张后椎动脉起始部狭窄后远端血管直径测量值增大,对球囊预扩张前椎动脉起始部狭窄后远端血管直径<4 mm或椎动脉起始部狭窄率80%~99%的患者选择支架型号更有指导意义。Objective To explore the effect of balloon pre-dilatation on the selection of stent size in patients with vertebral artery ostium stenosis.Methods Sixty nine patients who underwent stent implantation at the vertebral artery ostium in Taizhou First People's Hospital from January 2017 to December 2020 were enrolled.The diameters of the distal vessel of the stenosis at vertebral artery ostium before and after balloon pre-dilatation were measured and compared.The effect of balloon pre-dilatation on selection of stent size was analyzed by logistic regression.Results The diameter of the distal vessel of the stenosis at the vertebral artery ostium after balloon pre-dilatation[(4.35±0.79)mm]was larger than that before balloon pre-dilatation[(4.19±0.82)mm](t=-9.16,P<0.01).The proportion of patients with distal vessel diameter<4 mm before balloon pre-dilatation was higher in patients with stent size change than that without stent size change(P<0.01).Compared to patients with stenosis rate of 50%-<80%,the selected stent size changed more in patients with stenosis rate of 80%-99%(P<0.05).Logistic regression analysis showed that the distal diameter of vertebral artery ostium stenosis<4 mm and the stenosis rate 80%-99%(all P<0.05)were influencing factors of stent size change.Conclusion After balloon pre-dilatation,the measured value of distal vessel diameter is increased,particularly for patients with distal vessel diameter<4 mm and with 80%-99% stenosis at the vertebral artery ostium.

关 键 词：椎动脉起始部 狭窄 球囊扩张 

分 类 号：R651.1[医药卫生—外科学]