老年下肢血管介入治疗后再狭窄的影响因素

目的分析老年下肢动脉硬化闭塞症(ASO)患者经皮腔内血管成形术(PTA)后再狭窄的影响因素。方法回顾性分析2018年1月至2019年10月泸州市西南医科大学附属医院血管外科符合条件的98例老年下肢ASO患者的临床资料,对比不同性别、年龄、血管内支架植入状况、病变部位、残余狭窄、Rutherford分级患者的再狭窄发生率,对比发生与未发生再狭窄患者的踝肱指数与超敏C反应蛋白(hs-CRP)、糖化血红蛋白(GHb)水平。结果膝下血管病变患者的再狭窄发生率明显高于膝上血管病变患者,血管内支架植入患者的再狭窄发生率明显低于未植入患者,发生再狭窄患者的hs-CRP、GHb水平明显高于未发生再狭窄患者,差异均有统计学意义(均P0.05);多项Logistic回归分析结果显示,膝下血管病变、hs-CRP过表达、GHb过表达是下肢ASO患者PTA治疗后再狭窄的危险因素(OR1,P0.05),血管内支架植入是下肢ASO患者PTA治疗后发生再狭窄的保护因素(OR1,P0.05)。结论下肢ASO患者PTA治疗后再狭窄的发生与膝下血管病变、hs-CRP过表达、GHb过表达有密切关系,对于有上述危险因素的下肢ASO患者在PTA围术期应积极给予合理干预,而PTA联合血管内支架植入有利于减少再狭窄发生。     

支架成形术治疗老年症状性颅内椎动脉粥样硬化性重度狭窄长期随访结果

目的本研究通过长期随访评估支架成形术治疗老年症状性颅内椎动脉粥样硬化性重度狭窄的安全性及有效性。方法选择支架成形术治疗症状性颅内椎动脉粥样硬化性重度狭窄患者40例。采用多模态影像指导下的支架成形术治疗方法。术后6个月行数字减影血管造影术明确支架再狭窄情况。随访主要观察指标包括围术期任何脑卒中或死亡,随访期供血区脑卒中复发和支架再狭窄情况。结果 40例患者中,手术技术成功率100%,术前平均狭窄率为(82.3±9.6)%,术后平均狭窄率为(23.3±12.0)%。围术期无神经系统并发症和死亡。随访3~64(34.9±18.5)个月。随访期内因支架内闭塞发生严重供血区缺血性脑卒中1例(2.5%)。接受数字减影血管造影术复查25例(62.5%),支架内再狭窄12例(48.0%),包括支架内闭塞3例。Enterprise支架内再狭窄率高于Wingspan支架及Apollo支架,但差异无统计学意义(71.4%vs 38.5%、40.0%,P>0.05)。治疗后支架残余狭窄率>35%的患者支架内再狭窄率高于残余狭窄率<35%的患者,差异无统计学意义(75.0%vs 42.9%,P>0.05)。结论支架成形术治疗老年症状性颅内椎动脉粥样硬化性重度狭窄是安全、有效的。     

锁骨下动脉狭窄性疾病的介入治疗

目的探讨锁骨下动脉狭窄或闭塞性疾病的介入治疗疗效。方法回顾分析55例锁骨下动脉狭窄或闭塞病变行血管内介入治疗的临床资料。结果46例锁骨下动脉狭窄病变（狭窄率〉70%）成功置入支架,9例闭塞锁骨下动脉中8例成功置入支架。46例经股动脉置入支架,8例经肱动脉逆行置入支架。锁骨下动脉支架成功置入后肱动脉及桡动脉搏动良好,伴有盗血现象的13例患者症状消失。随访发现5例锁骨下动脉支架置入后9~12个月再狭窄,后再置入5枚支架,血管开通良好。结论应用血管内支架治疗锁骨下动脉狭窄或闭塞是一种微创、安全、有效的治疗方法,有望成为主要的治疗手段。     

股腘动脉支架内再狭窄的腔内治疗研究进展

正股腘动脉(FPA)支架置入血管成形术是针对FPA狭窄或闭塞性病变的腔内治疗方法之一,其目的是改善患者下肢动脉血液供应,缓解患者因下肢缺血引发的间歇性跛行和静息痛等症状。然而在支架置入术后可导致FPA支架内再狭窄(FPA-ISR)。有文献报道,支架后再狭窄或闭塞的发生率高达20%~50%[1-2]。而一旦发生支架内再狭窄(ISR),就会再现下肢缺血,因此对于FPA-ISR的治疗方法相继出现,现将就目前SFA腔内治疗研究进展进行综述。     

药物治疗预防下肢动脉支架成形术后再狭窄的临床观察

目的:观察抗血小板药物在下肢动脉支架成形术后预防再狭窄的效果。方法:收集2008年1月至2010年12月,下肢动脉血管内支架治疗的下肢动脉硬化闭塞症(ASO)患者74例,随机分为治疗组(36例),每日口服盐酸沙格雷脂+拜阿司匹林;对照组(38例)每日皮下注射低分子肝素1 w,并从术后第3天起口服华法令。观察术后6个月、12个月及18个月支架内闭塞、再狭窄以及临床出血。结果:两组患者基本特征比较,差异无统计学意义(P>0.05)。治疗组和对照组:18个月的再闭塞分别是1例和2例,两组比较,差异无统计学意义(P>0.05);支架内再狭窄分别是1例和8例,两组比较,差异有统计学意义(P﹤0.05);出血并发症分别是1例和4例,两组比较差异无统计学意义(P>0.05)。结论:盐酸沙格雷脂联合阿司匹林,可以预防下肢动脉支架成形术后的再狭窄,安全有效。     

球囊扩张式支架治疗大脑中动脉狭窄67例临床随访研究

目的探讨球囊扩张式支架治疗症状性动脉粥样硬化性大脑中动脉(MCA)狭窄的临床效果及其安全性,评价合理的术后随访辅助检查手段。方法收集并分析河北医科大学第二医院2013年1月至2017年4月收治的67例经球囊扩张式支架治疗的动脉粥样硬化性MCA狭窄患者的临床资料及其随访数据。结果球囊扩张式支架手术治疗技术成功率为98.51%(66/67)。症状性围手术期并发症发生率为4.48%(3/67)。对全部患者进行随访,评价支架内情况的辅助检查方式为经颅多普勒(TCD)或全脑血管造影术(DSA)。支架内再狭窄或闭塞发生率为8.96%(6/67),TCD对支架内再狭窄或闭塞的检查结果同DSA的符合率为75.00%,症状性支架内再狭窄或闭塞发生率为2.99%(2/67),另外发现2例虽有支架置入脑血管相关区域再发卒中但未发现支架内再狭窄,随访1年内支架相关区域症状性脑血管事件总发生率为10.44%(7/67)。结论球囊扩张式支架治疗症状性动脉粥样硬化性MCA狭窄临床效果较好,其围手术期并发症发生率较低,术后支架相关区域脑卒中发生率低。TCD是进行大脑中动脉支架术后随访的有效方式,可以对支架内再狭窄起到早期发现的作用,并且同DSA的一致率较高。     

Wingspan支架治疗后循环症状性颅内动脉狭窄的疗效

目的 分析Wingspan支架治疗后循环症状性颅内动脉狭窄的临床疗效.方法 回顾分析采用Wingspan支架系统行血管成形术治疗30例后循环症状性颅内动脉狭窄患者的临床资料,观察手术成功率,采用数字减影血管造影(DSA)测定治疗前后狭窄的部位狭窄程度改善情况,观察术后症状及并发症情况.记录随访期间的再狭窄发生情况.结果 手术成功率为100％,动脉狭窄程度由(74.6±13.6)％降为(14.8±4.5)％(t=13.469,P ＜0.01),术后并发症比例为10％,随访期间共计出现5例支架内再狭窄,再狭窄率为16.67％,均为无症状性再狭窄,无患者死亡.结论 Wingspan支架治疗后循环症状性颅内动脉狭窄临床疗效确切,有效改善患者症状、神经功能与预后,是一种安全、有效的方法.     

Enterprise支架治疗老年症状性大脑中动脉狭窄患者的安全性和有效性

目的评估Enterprise支架治疗老年症状性大脑中动脉狭窄患者的安全性及有效性。方法回顾性分析2013年1月~2015年12月在火箭军总医院神经介入医学科接受Enterprise支架治疗的症状性大脑中动脉重度狭窄,且年龄≥60岁的患者55例,其中男性31例,女性24例,年龄60~81(66.4±8.0)岁。术前及术后给予双联抗血小板聚集药物及强化调脂治疗,采取多模态影像指导下的支架成形术,术后6个月行全脑数字减影血管造影(DSA)明确支架再狭窄情况,观察围术期并发症发生率、支架内再狭窄发生率及靶血管供血区脑卒中复发率。结果手术技术成功率100.0%,术前及术后即刻残留狭窄率(86.6±10.0)%、(29.9±13.2)%。围术期发生1例(1.8%)穿支脑梗死事件,术后随访期有1例脑出血,2例支架内急性闭塞,1例短暂性脑缺血发作事件,术侧大脑中动脉供血区缺血性脑卒中发生率为3.6%。有36例(65.5%)患者接受了DSA复查,血管狭窄率为(34.3±22.8)%,8例(22.2%)患者出现支架内再狭窄。结论 Enterprise支架治疗老年症状性大脑中动脉重度狭窄患者是安全的,且能有效预防供血区脑卒中复发。     

冠状动脉内球囊扩张成形术治疗Gianturco-RoubinⅡ型支架内再狭窄

目的 观察经文冠状动脉腔内成形术(PTCA)治疗Gianturco-RoubinⅡ(GRⅡ)型支架内再狭窄的疗效并探讨其机理.方法和结果 在成功植入GRⅡ型支架后6个月行血管造影,对20例患者的22条支架内再狭窄血管再次行PTCA术.手术成功率为96%(21/22),4例完全闭塞病变中有1例失败是因导丝不能通过闭塞处.无死亡,无急性或亚急性闭塞并发症.定量血管造影显示:平均最狭窄处血管直径从(0.85±0.34)mm增加到(2.32±0.41)mm,平均狭窄程度由(71±16)%下降至(18±12)%,而手术前后支架本身变化不明显.结论 重复PTCA术治疗GRⅡ型支架内再狭窄,安全有效,成功率高,并发症少.管腔扩大的原理主要为动脉样硬化班块组织被挤出支架.     

锁骨下动脉闭塞或重度狭窄血管内治疗疗效及安全性分析

目的研究症状性锁骨下动脉闭塞或重度狭窄血管内治疗的疗效和安全性。方法选择31例症状性锁骨下动脉闭塞或重度狭窄的患者行血管内自膨式支架成形术,分析其疗效及安全性。结果31例症状性锁骨下动脉闭塞或重度狭窄患者中,均用自膨式支架成功完成血管内支架成形术,术后锁骨下动脉狭窄率明显改善、锁骨下动脉盗血综合征和上肢缺血症状明显改善,无并发症出现。结论采用自膨式支架治疗症状性锁骨下动脉闭塞或重度狭窄是一种微创、安全、有效的治疗方法。     

Drug-eluting stent implantation for treatment of recurrent renal artery in-stent restenosis.

Percutaneous renal artery stenting has become the treatment of choice for renal artery stenosis. In-stent restenosis (ISR) still remains a persistent problem. Drug eluting stents have significantly reduced the incidence of ISR in coronary arteries. We report a case in which recurrent renal ISR was successfully treated with paclitaxel-eluting stent implantation, using intravascular ultrasound guidance, with maintained stent patency at 6 months.     

Covered stent for the treatment of recurrent bilateral renal artery in-stent restenosis

The optimal treatment for renal artery in-stent restenosis (ISR) is not well established. Reintervention with different strategies including balloon angioplasty, cutting-balloon angioplasty, additional stenting with bare-metal, drug-eluting or covered stents and brachytherapy are effective in achieving immediate angiographic success. However, recurrent ISR rates are high irrespective of treatment strategy. We present a case describing the use of a covered stent for the treatment of recurrent bilateral renal artery ISR after bare-metal and drug-eluting stent implantation and cutting-balloon angioplasty.     

Bioresorbable vascular scaffold for coronary in-stent restenosis: A novel concept

The management of patients with significant in-stent restenosis (ISR) with drug-eluting stent is still not well defined. Various treatment modalities include plain old balloon angioplasty (POBA), metallic stent, cutting or scoring balloon and drug-eluting balloon (DEB). Bioresorbable vascular scaffold (BVS) is the latest technology for the treatment of de novo coronary artery lesions. The use of BVS in ISR is based on the rationale of local drug delivery as achieved by DEB without the permanent bi-layer of metal and also stabilizes dissection flaps and prevents acute recoil as provided by metallic stent. To the best of our knowledge this is the first case report of the use of BVS in patient with ISR.     

ISR II study: a long-term evaluation of sirolimus-eluting stent in the treatment of patients with in-stent restenotic native coronary artery lesions.

The aim of this pilot study was to determine the safety and long-term efficacy of treating intrastent restenosis (ISR) with the slow-release sirolimus-eluting stent Bx Velocity (Cypher stent) without intravascular ultrasound (IVUS) guidance. Of patients who received a bare metal stent implantation and presented an ISR, 30-80% of the patients will develop a second restenosis within the stent, at the stent edges or both. To date, intravascular brachytherapy using beta- and gamma-radiation has been the only effective treatment for ISR. Twenty-three patients with ISR and evidence of ischemia were treated with Cypher stent. Clinical information was collected 1, 8, 12, and 24 months after stent implantation. During the first 8 months of the study, in-stent lumen diameter remained essentially unchanged from postprocedure in 80% of the case. The target lesion repeat revascularization (TLR) was 17%, of which 50% were oculostenotic reflexes. Only one patient presented a restenosis greater than 70%. During the 2-year study period, the TLR rate was 17%; the major adverse coronary event rate was 26%, and the non-Q-wave myocardial infarction (MI) rate was 9%. There were no reports of death, coronary artery bypass grafting, or Q-wave MI during the study. This study demonstrates the feasibility of using sirolimus-eluting stents without IVUS guidance for the treatment of ISR, providing long-term stability of immediate results.     

Correlates of clinical restenosis following intracoronary implantation of drug-eluting stents

Despite significant decreases in restenosis and repeated intervention achieved using drug-eluting stents (DESs), the benefit has not been homogenous across all patient and lesion subsets. Identification of correlates of DES restenosis may allow a differing management approach and lead to improved patient outcomes. The study population consisted of 3,535 consecutive patients (5,046 lesions) who underwent successful sirolimus- or paclitaxel-eluting stent implantation for >or=1 native coronary artery or bypass graft lesion from April 2003 to September 2006. From this cohort, 197 patients (237 lesions) were identified to have in-stent restenosis (ISR) requiring revascularization within 12 months of stent implantation. This group was compared with the remainder of the patient population. Logistic regression analysis was performed to identify independent predictors of DES ISR. Independent correlates of DES ISR using multivariate analysis included both clinical and procedural factors. Clinical predictors were age, hypertension, and unstable angina. Procedural predictors were left anterior descending artery intervention, number of stents implanted, stented length/lesion, and lack of intravascular ultrasound guidance. Implantation of >or=3 stents was associated with a significantly higher restenosis risk (9.7% vs 5.1%; p=0.0003). A 10-mm increase in stented length was associated with an adjusted odds ratio of 1.18 (95% confidence interval 1.03 to 1.35). Diabetes, stent diameter, and stent type were found not to be predictive of DES ISR. In conclusion, correlates of DES ISR included both clinical and procedural factors. Limiting the number of stents and stented length, in addition to intravascular ultrasound guidance, may minimize DES ISR.     

Drug-eluting stent for recurrent mesenteric artery in-stent restenosis.

PURPOSE: To report the use of a drug-eluting stent (DES) for treatment of symptomatic in-stent restenosis (ISR) in the superior mesenteric artery (SMA). CASE REPORT: A 79-year-old woman suffering from chronic renal failure and needing dialysis was admitted for vomiting, postprandial abdominal pain, and weight loss for 3 months. Computed tomographic angiography (CTA) documented massive calcification of the vascular bed, mainly in the aorta, and a very tight ostial stenosis of the SMA. A 4.5-x20-mm Genesis stent was deployed at the ostium, with good angiographic result and immediate symptomatic benefit. After 3 months, symptoms recurred; angiography demonstrated ISR. Percutaneous angioplasty with a 4-x15-mm cutting balloon was performed. The patient remained asymptomatic for only 2 months; recurrent ISR at this time was treated with a 3.5-x24-mm coronary TAXUS Express paclitaxel-eluting coronary stent deployed inside the previously implanted stent. Under prolonged double antiplatelet regimen, the patient was asymptomatic at the 8-month follow-up; CTA demonstrated patency of the SMA. CONCLUSION: Considering the high rate of restenosis and the periprocedural complications described with endovascular treatment of SMA stenosis, a drug-eluting stent may be a good option not only for the treatment of restenosis but also in de novo lesions, at least when the vessel diameter is <4.5 mm.     

老年冠心病患者支架内再狭窄危险因素分析

目的 探讨老年冠心病患者冠脉支架术后支架内再狭窄(ISR)的危险因素.方法 选取2016年1月-2019年12月在复旦大学附属华东医院心内科行经皮冠状动脉支架植入术,并于术后12个月常规复查冠脉造影的老年冠心病患者共208例作为研究对象,根据是否发生ISR,他们被分为ISR组(24例)和非ISR组(184例),比较2组...     

Management of a broken guiding catheter tip: Cut and fix technique

A 49-year-old male presented with class III exertional angina, 1 year after angioplasty of the left anterior descending artery (LAD) and right coronary artery. Coronary angiogram revealed 90% in-stent restenosis (ISR) in mid-LAD with angiographic impression of stent fracture. Optical coherence tomographic evaluation of mid-LAD ISR showed a distinct 3 mm long “eclipse sign” indicating embolized, broken guiding catheter tip as a cause of ISR, which was confirmed on reviewing 1-year-old angiographic images. This was managed with “cut and fix technique” using cutting balloon and another drug-eluting stent. Optical coherence tomographic at 9 months showed well endothelialized stent with a thin layer of neo-intimal hyperplasia over the sandwiched broken guiding tip.     

Use of a cutting balloon and a paclitaxel-coated balloon to treat recurrent subclavian in-stent restenosis causing coronary subclavian steal syndrome

A 56-year-old male with a past history of coronary artery bypass graft surgery underwent stent implantation for a severe proximal left subclavian artery stenosis. Recurrent in-stent restenosis (ISR) resulted in the coronary subclavian steal syndrome (CSSS), with angina due to compromised blood flow in the left internal mammary artery/radial composite bypass graft. This was treated with cutting balloon predilatation followed by paclitaxel-coated balloon (PCB) dilatation, with an excellent angiographic result. At 10 months of follow-up, blood pressure in both arms was equal, and the patient remained symptom free. To our knowledge, this is the first report of successful treatment of subclavian ISR causing CSSS with a PCB.