症状性大脑中动脉狭窄患者支架置入术后再狭窄影响因素的分析

Restenosis in patients with symptomatic middle cerebral artery stenosis after stenting:an analysis of influencing factors

目的 探讨症状性大脑中动脉（MCA）狭窄患者支架置入术后再狭窄的影响因素。方法 回顾性分析113例症状性MCA狭窄并且行支架置入术患者的临床资料，以TCD、DSA随访支架置入后的再狭窄率。狭窄率判定标准参照北美症状性颈动脉内膜切除试验的方法，术后MCA狭窄率〉50％为再狭窄。按MCA狭窄长度分为〈5mm、5～10mm、〉10mm；按置入支架类型分为裸支架与药物支架。分析MCA狭窄长度、置入支架种类及危险因素与再狭窄的相关性。对有、无相关危险因素再狭窄率的差异显著性采用卡方检验。结果 113例患者有161处狭窄，置入支架129枚。术前MCA平均狭窄率为（80．8±8．8）％，术后即刻平均狭窄率为（3．7±8．2）％。随访89例患者（78．8％），平均随访时间为（28．7±16．4）个月（3个月至5年）。TCD随访63例；随访26例。16例（16／89，17．9％）出现〉50％的再狭窄，其中病变长度〈5mm者再狭窄4例（4／39。10．2％），5～10mm者11例（11／47，23．4％），〉10mm1例（1／3）。置入裸支架后再狭窄15例（15／80，18．8％），置入药物洗脱支架再狭窄1例（1／9）。16例再狭窄患者伴糖尿病11例、高血压10例、高脂血症6例、糖尿病＋高血压4例、吸烟9例、饮酒5例及冠心病2例。有、无相关危险因素的再狭窄率差异无统计学意义，P均〉0．05。结论 术后再狭窄原因可能与支架类型有关，不除外与糖尿病有关。其他影响因素尚待进一步研究。

Objective To investigate the influencing factors of restenosis in patients with symptomatic middle cerebral artery （MCA） stenosis after stenting. Methods The clinical data of 113 patients with symptomatic MCA stenosis who had stenting were analyzed retrospectively. The restenosis rate after stenting was followed-up with transcranial Doppler （TCD） and digital subtraction angiography （DSA）. The standard of criterion of stenotic degree referred to North American Symptomatic Carotid Endarterectomy Trial （NASCET）. The degree of MCA stenosis 〉 50% after stenting was defined as restenosis. They were divided into 〈5 mm, 5-10 mm and 〉 10 mm according to the length of MCA stenosis; and they were divided into bare stents and drug-eluting stents according to the type of stent. The length of MCA stenosis, type of stent, risk factors and their correlations with restenosis were analyzed. The significant differences for the restenosis rate with and without related risk factors were examined by chi-square test. Results There were 161 stenosis in 113 patients, and 129 stents were placed in these patients. The mean stenosis rate of the MCAs before the procedure was 80. 8 ± 8. 8% ; and immediately after the procedure was 3.7 ± 8. 2%.A total of 89 patients （78. 8% ） were followed-up, and their mean follow-up time was 3 months to 5 years （28. 7 ± 16.4）. Sixty-three patients were followed-up with TCD, and 26 with angiography. Sixteen patients （ 16/89, 17.9% ） had restenosis of less than 50% , of which the length of lesion was 〈 5 mm in 4 patients （4/39, 10. 2% ）, 5 -10 mm in 11 patients （ 11/47, 23.4% ）, and 〉 10 mm in 1 patient （1/3）. Fifteen patients （ 15/80, 18. 8% ） had restenosis after the bare stent placement, and 1 patient （1/9） had restenosis after the drug eluting stent placement. Of the 16 restenosis patients, 11 had diabetes, 10 had hypertension, 6 had hyperlipoidemia, 4 had both diabetes and hypertension, 9 were smokers, 5 were drinkers, and 2 had coronary heart disease. There was no significant difference in the restenosis rate with and without related risk factors （P all 〉 0. 05）. Conclusion Stent placement for the treatment of MCA stenosis is safe and effective. The cause of restenosis after stenting may be associated with the type of stent, and the risk factors of diabetes can＇t be excluded. They remain to be further studied.