肾动脉内支架成形术的临床应用

Clinicalapplicationofstentangioplastyinthetreatmentofrenalarterialstenoses

目的：对肾动脉阻塞性病变采用Ｐａｌｍａｚ内支架进行治疗，并对其临床远期疗效进行前瞻性、非随机研究分析。材料与方法：７例（２６％）为经皮肾动脉气囊成形术（ＰＴＲＡ）治疗失败者，１３例（４８％）为ＰＴＲＡ后病变再狭窄，４例（１５％）为ＰＴＲＡ后出现并发症，３例（１１％）为肾动脉开口处狭窄直接作内支架治疗。共有４枚Ｐａｌｍａｚ内支架、５枚Ｐａｌｍａｚ－Ｓｃｈａｔｓ节段性内支架及１８枚Ｐａｌｍａｚ中号内支架被用于本组病例，内支架透视导向下用气囊导管及８Ｆ导引鞘释放到靶血管段。结果：技术成功率为１００％（残余狭窄＜３０％），未发生严重并发症，病变两端平均压差从６．８±１．５ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至０ｋＰａ（Ｐ＜０．０５），随访结果（３～３２个月，平均１０±６个月）显示４例治愈，２０例缓解，总有效率８９％，平均收缩压从术前２４．８±３．０ｋＰａ降至１８．９±２．０ｋＰａ，舒张压从１４．７±１．３ｋＰａ降至１１．３±１．５ｋＰａ（Ｐ＜０．０５），６例肾功能衰竭病人中有２例术后肾功能改善，另４例稳定不变，２例分别于术后３、１８个月出现病变内再狭窄，但未出现临床症状，病变两端压力差改变不显著。结论：常规ＰＴＲＡ?

Purpose:ToevaluatethetherapeuticresultsofPalmazexpandablestentfortreatmentofrenalarterialobstructivedisease.Materialsandmethods:Aprospectiveandnon-randomizedstudywasmadein27patients.Theindicationsforstentplacementwereelasticrecoilofrenalarteriesim-mediatelyafterconventionalPTRA(n=7,26%),restenosisafterPTRA(n=13,48%),complica-tionsofPTRA(n=4,15%)andostialstenosis(n=3,11%).4Palmazcoronarystents,5Palmaz-Schatssegmentalstentsand18Palmazmiddlesizestentswereimplantedbyusingbalooncatheterand8Fguidingcatheterundertheguidanceofflouroscopy.Results:Technicalsuccess(residualstenosis<30%)wasachievedinalpatientswithoutseriouscomplications.Thetransstenoticpres-suregradientdecreasedsignificantlyfrom6.8±1.5kPa(51±11mmHg)to0kPa(P<0.05).Duringthefolow-up(3 32months;mean,10±6months),hypertensionwasimprovedin20patientsandcuredin4patientswithatotalbenefitof89%.Theaveragesystolicbloodpresuredecreasedfrom24.8±3.0kPa(186±23mmHg)to18.9±2.0kPa(142±15mmHg)andtheaveragediastolicbloodpressuredecreasedfrom14.7±1.3kPa(110±10mmHg)to11.3±1.5kPa(85±11mmHg)afterstenttreatment(P<0.05).2of6patientsdemonstratedimprovedrenalfunctionafterstenting,theremainingfourpatientsremainedstable.Folow-upangiographywasperformedinalpatientsanddemonstratedexcelentmorphologicresults;2casesshowedarestenosiswithoutasignificantpres-suregradientortheneedfrofurthertreatment.Conclusion:Inthislimitedseries,renalarterystentangioplastywashighlybeneficialforpatientswhohadpoorresultsfromconventionalangioplasty.Patientswithostiallesionswereprimarilytreatedwithstents,however,thenumberofcasesistolowtowarrantgeneralrecommendation,butourresultsareencouraging.