彩色多普勒超声评估阿托伐他汀钙对椎动脉支架置入后再狭窄的作用

Evaluation of the effect of atorvastatin on preventing restenosis after vertebral artery stenting with color Doppler flow imaging

目的应用彩色多普勒超声(CDFI)评价阿托伐他汀钙在预防椎动脉起始段支架置入后再狭窄的作用。方法纳入59例行单侧椎动脉起始段支架置入术且随访资料完整的患者。根据术后是否服用阿托伐他汀钙(20mg/d),将患者分为服药组(29例)和未服药组(30例),术后均给予两组患者阿司匹林100 mg/d和氯吡格雷75 mg/d。于支架置入术前,术后1、6及12个月行CDFI检查,记录椎动脉起始段及椎间隙段的收缩期峰值流速(PSV_(OS),PSV_(IV)),计算PSV_(OS)/PSV_(IV),以DSA显示支架内狭窄率≥50%者为术后再狭窄,比较分析两组间再狭窄发生率及血流动力学的变化。结果①术后6个月,服药组和未服药组的再狭窄率分别为20.7%(6/29)和36.7%(11/30),差异无统计学意义,P>0.05;术后12个月,未服药组再狭窄率(50.0%)明显高于服药组(20.7%),差异有统计学意义,P<0.05。②术后1个月,两组患者的PSV_(OS)及PSV_(OS)/PSV_(IV)均较术前明显改善。术后6个月,未服药组较服药组患者的PSV_(OS)s[(187±18)、(179±20)cm/s]和PSV_(OS)/PSV_(IV)(3.93±0.59,3.24±0.48)相对升高,但差异无统计学意义。术后12个月时,未服药组较服药组患者的PSV_(OS)[(209±21)cm/s、(159±16)cm/s]和PSV_(OS)/PSV_(IV)(4.34±0.65、2.86±0.36)显著增高,差异有统计学意义,P<0.05。结论 CDFI评估结果显示,阿托伐他汀钙可以降低椎动脉支架置入术后再狭窄率。随着服药时间的延长,可影响病变血管内血流动力学的变化。

Objective To evaluate the effect of atorvastatin on the prevention of restenosis after vertebral artery origin stenting with color Doppler flow imaging （CDFI）. Methods A total of 59 patients with complete clinical data underwent unilateral vertebral artery origin stenting were recruited in the study. The patients were divided into drug （ n = 29） and non-drug （ n = 30） groups according to whether they took atorvastatin （20 mg/d） or not. All the patients were detected by CDFI before and at 1, 6, and 12 months after stenting. The peak systolic velocity （PSV） at the proximal （ PSVos ） and intervertebral segments of vertebral artery（ PSVIV ） were recorded and the ratio of PSVos/PSVIV was calculated. Digital subtraction angiography （DSA） showed that the in-stent stenosis rate ≥50% was determined as postoperative restenosis. The incidence of restenosis and hemodynamic changes were compared between the two groups. Results （1）The restenosis rates of the drug and non-drug groups at 6 months after stenting were 20. 7% （6/29） and 36.7% （11/30） respectively （P 〉 0. 05 ） ; the restenosis rate （50.0%） of the non-drug group（50% ） was significantly higher than that of the drug group （20.7%） at 12 months after stenting （ P 〈 0.05 ）. （2）The PSVos and PSVos/PSV IV of the patients in both groups at 1 month after stenting were improved more significantly than those before the procedure. PSVos （187 ± 18 cm/s, 179 ± 20 cm/s） and PSVos/PSV IV （3.93 ± 0.59, 3.24 ± 0.48） were relatively increased in the non-drug group at 6 months after the procedure, but there was no significant difference. PSVos （209 ± 21 cm/s, 159 ± 16cm/s） and PSVos/PSV IV （4.34 ±0.65, 2.86 ±0.36） in the non-drug group at 12 months after stenting were significantly higher than those in the drug group. There was significant difference between the two groups （P 〈0. 05）. Conclusions Atorvastatin can decrease the restenosis rate after vertebral artery stenting. With the prolonged time of drug treatment, it may affect the hemodynamic changes in the abnormal vessels.