椎动脉起始部支架内再狭窄的治疗及预后分析  

Analysis of treatment and prognosis of in-stent restenosis after vertebral artery origin stent angioplasty

作　　者：李谈[1] 朴柄达 钟红亮[2] 杨洪超 贾建文[2] 汪阳 刘赫[2] Li Tan;Piao Bingda;Zhong Hongliang;Yang Hongchao;Jia Jianwen;Wang Yang;Liu He(Department of Vascular Surgery,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Neurosurgery,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020 [2]首都医科大学附属北京朝阳医院神经外科,北京100020

出　　处：《血管与腔内血管外科杂志》2023年第3期270-274,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨椎动脉起始部支架成形术后支架内再狭窄(ISR)患者的治疗与预后。方法收集2008年1月至2022年7月于首都医科大学附属北京朝阳医院因动脉粥样硬化性重度狭窄而行椎动脉起始部支架成形术治疗的147例患者的临床资料,分析支架成形术前与术后狭窄率,ISR发生情况,ISR症状与椎动脉直径、供血侧别的关系,不同ISR症状患者的治疗及预后情况。结果147例患者的手术成功率为100%,共20例患者发生ISR,其中,症状加重的ISR患者9例,症状未加重或无症状的ISR患者11例;椎动脉直径≥3.5mm患者7例,椎动脉直径﹤3.5 mm患者13例;优势及均势供血侧患者4例,非优势供血侧患者16例。未发生ISR患者和发生ISR患者的术前动脉狭窄率分别为(73.7±7.6)%、(76.4±8.3)%,术后动脉狭窄率分别为7.4%(6.1%,9.6%)和8.9%(7.4%,10.3%)。症状加重的ISR患者的术前动脉狭窄率为(79.4±7.1)%,术后动脉狭窄率为9.4%(8.2%,11.4%);症状未加重或无症状的ISR患者的术前动脉狭窄率为(75.2±8.1)%,术后动脉狭窄率为7.5%(6.8%,8.6%)。不同病变动脉直径、供血侧别动脉粥样硬化性重度狭窄患者的术后ISR发生情况及症状情况比较,差异均有统计学意义(P﹤0.05)。随访期间,发生ISR的患者均未见新发症状及症状未再次加重。结论ISR更易发生于椎动脉直径﹤3.5 mm或非优势供血侧,但发生ISR后大部分患者症状较轻,可通过介入治疗或药物治疗获得较好的预后。椎动脉直径≥3.5 mm或优势及均势供血侧发生ISR的风险较低,一旦发生ISR,患者的症状可能明显加重,可以通过再次行球囊扩张或支架成形术获得较好的预后。Objective To investigate the treatment and prognosis of in-stent restenosis(ISR)after vertebral artery origin stent angioplasty.Method Clinical data of 147 patients with severe atherosclerotic stenosis treated with stent angioplasty at vertebral artery origin in Beijing Chao-Yang Hospital,Capital Medical University from January 2008 to July 2022 were collected.The stenosis rate before and after stent angioplasty,occurrence of ISR,relationship of ISR symptoms with vertebral artery diameter and the dominant side,and the treatment and prognosis of ISR patients with different symptoms were analyzed.Result The successful rate of surgery was 100%in 147 patients,in which,20 patients experienced ISR,including 9 cases of progression of ISR symptoms and 11 non-progressive or asymptomatic patients;there were 7 patients with vertebral artery diameter≥3.5 mm and 13 patients<3.5 mm;there were 4 cases of dominant and balance blood supply side,and 16 cases of non-dominant blood supply side.The preoperative artery stenosis rate was(73.7±7.6)%and(76.4±8.3)%respectively in patients without and with ISR,and the postoperative artery stenosis rate was 7.4%(6.1%,9.6%)and 8.9%(7.4%,10.3%)respectively.The preoperative artery stenosis rate was(79.4±7.1)%,and postoperative artery stenosis rate was 9.4%(8.2%,11.4%)for ISR with worsening symptoms;the preoperative artery stenosis rate was(75.2±8.1)%and the postoperative artery stenosis rate was 7.5%(6.8%,8.6%)for ISR without worsening symptoms.There were significant differences for the occurrence of postoperative ISR and symptoms in severe atherosclerotic stenosis patients with different involved arterial diameter and dominant side(P<0.05).There were no new symptoms and progression of symptoms in ISR patients during follow up.Conclusion The artery diameter<3.5 mm or the non-dominance blood supply side is more prone to ISR.However,most patients with ISR have mild symptoms and can achieve a better prognosis through interventional therapy or drug treatment.The risk of ISR is lower on the a

关 键 词：支架 支架内再狭窄 椎动脉起始部 支架成形术 预后 

分 类 号：R543[医药卫生—心血管疾病]