应用超声评估颈动脉支架置入后残余狭窄的影响因素

目的应用彩色多普勒血流显像(CDFI)分析颈动脉支架置入术(CAS)后残余狭窄的发生率及其影响因素。方法前瞻性纳入2008年1月—2011年12月在首都医科大学宣武医院接受CAS的患者423例(434枚支架)。术后1周内行CDFI检查。根据术后DSA影像及CDFI的结果判定残余狭窄率。分析颈动脉斑块的声波特征、形态学的变化及支架的类型(开环式和闭环式)对CAS术后残余狭窄发生率的影响。结果①术后残余狭窄的发生率为31.1%(135/434),其中98.5%(133/135)的残余狭窄率﹤50%,1.5%(2/135)残余狭窄率≥50%。②不均质回声斑块患者的残余狭窄的发生率为34.1%,高于均质回声斑块的24.8%,P<0.05。在均质回声斑块患者中,强回声斑块者残余狭窄的发生率为48.6%,高于等回声和低回声斑块组的17.9%、14.6%,P=0.002、P=0.001;不均质回声斑块患者中,斑块基底部钙化者残余狭窄的发生率为51.3%,高于无基底部斑块钙化者的28.1%,P=0.000。不规则形态斑块的患者,残余狭窄的发生率为35.7%,高于规则形态斑块者的26.1%,P=0.031。③置入开环式支架和闭环式支架后,残余狭窄的发生率分别为30.6%(110/360)、33.8%(25/74),差异无统计学意义,P=0.585。④多因素Logistic回归分析显示,基底部钙化斑块(OR=2.658,95%CI:1.598～4.560)、强回声斑块(OR=4.609,95%CI:1.994～10.657)是影响残余狭窄的独立危险因素。结论基底部钙化的不均质回声动脉粥样硬化斑块及单纯强回声斑块是造成CAS术后残余狭窄发生的独立危险因素。

Ultrasonographic evaluation of the influencing factors of residual stenosis after carotid arterystenting

Objective To analyze the incidence of residual stenosis and its influencing factors after carotid artei7 stenting （CAS） using color Doppler flow imaging （CDFI）. Methods A total of 423 patients （434 stents） who underwent CAS in Beijing Xuanwu Hospital,Capital Medical University from Janu- ary 2008 to December 2011 were enrolled prospectively. All patients received CDFI examination within 1 week after procedure. The residual stenosis was identified according to the results of digital subtraction angiography （DSA） and CDFI. The effects of echo characteristics of carotid artery plaques, morphological changes and stent types （open-cell and closed-cell stents） on the incidence of residual stenosis after CAS were analyzed. Results （~） The incidence of residual stenosis after procedure was 31. 1% （ 135/434 ） ,in which 98.5% （133/135） residual stenoses were 〈50% and 1.50/o （2/135） were≥50%. ②The incidence of residual stenosis in patients with heterogeneous echo plaque was 34.1% , which was higher than 24.8% of homogenous echo plaque （P 〈 0.05）. In patients with homogenous echo plaque,the incidence of residual stenosis in patients with hyperechoic plaque was 48.6% , which was higher than 17.9% and 14.6% in those with isoechoic and hypoechoic plaque groups （17.9% and 14.6% , P = 0. 002, P = 0.001）. In patients with heterogeneous echo plaque,the incidence of residual stenosis in patients withcalcification at the base was 51.3% ,which was higher than that in patients without calcification at the base （28.1% , P = 0. 000 ）. In patients with irregularly shaped plaque, the incidence of residual stenosis was 35.7% ,which was higher than 26.1% in patients with regularly shaped plaque （P =0.031 ）. ③After implanting open-cell and close-cell stents, the incidences of residual stenosis were 30.6% （110/360） and 33.8% （25/74） respectively （P = 0. 585 ）. The difference was not statistically significant （ P = 0. 585 ）. ④Multiple logistic regression analysis showed that the plaques with calcification at the base （0R,2. 658, 95% CI1. 598 -4. 560） and hyperechoic plaques （ OR,4. 609,95% CI1. 994 -10. 657） were the independent risk factors for influencing residual stenosis. Conclusion The heterogeneous echo plaques with calcification at the base of the plaques and simple hyperechoic plaques are the independent risk factors for causing residual stenosis after carotid artery stenting.