颈动脉支架术后结构改变与术前斑块性质的相关性

Relationship between the type of pre-interventional plaque and the stent expansion after carotid artery stenting in the patients with carotid atherosclerotic stenosis

目的:应用彩色多普勒超声对颈动脉狭窄支架植入术后的自膨胀结构进行分析,探讨斑块性质与支架术后自膨胀程度之间的关系。方法:43例(51条)颈动脉狭窄行自膨胀支架植入术患者,术前根据斑块的超声特征分为软斑块、纤维硬斑块、钙化斑块三种类型,在术后3d内、3、6、12、24个月分别测量支架近心端、中间段、远心端内径。结果:支架各节段内径在术后持续增大,其中以中间段最明显,并与术前的斑块性质有关,自膨胀程度比较,软斑块组>纤维硬斑块组>钙化斑块组。结论:术前为软斑块的支架植入术后疗效佳,而严重钙化斑的自膨胀相对较差,可考虑外科手术。

Objective To explore the relationship between the type of pre-interventional plaque and the stent expansion after carotid artery stenting in the patients with carotid atherosclerotic stenosis with duplex ultrasound scanning. Methods Forty-three consecutive patients with 51 successfully stented carotid arteries were examined with color-coded duplex ultrasound scanning at 3d and at 3, 6, 12 and 24 months after the stent procedure. The stent diameters at the proximal, middle, and distal region were recorded. Pre-interventional plaques were assigned to three types： soft, fibrous and largely calcified. Results The diameters of the self-expanding stents steadily increased over 2 years. Stent expansion was most marked in the middle stent area, depending on the type of pre-interventional plaque. The extent in stent expansion was more obvious in soft than in fibrous and calcified plaques. Conclnsions Expansion of the stent was most pronounced in soft plaques, poor stent expansion in heavily calcified plaques calls for primary surgical management.