应用超声随访颈动脉支架置入后再狭窄及其影响因素的分析

Restenosis after carotid artery stenting followed up with ultrasound and the analysis of its influencing factors

目的应用超声检测颈动脉支架置入术(CAS)后再狭窄的发生率,并分析其相关影响因素。方法前瞻性纳入2008年1月—2012年6月在首都医科大学宣武医院行CAS治疗的患者485例(502枚支架)。于术前,术后1周,术后3、6、12、24、36个月行彩色多普勒血流成像(CDFI)检测,评估CAS术前、术后颈动脉血流动力学变化及再狭窄发生情况。应用COX回归分析支架置入术前动脉粥样硬化斑块的不同声波特征、形态,置入的支架类型(开环式或闭环式),术后残余狭窄及疾病危险因素对CAS后支架内再狭窄的影响。结果随访中位数时间为24个月(1～36个月),随访期间支架再狭窄的检出率为8.2%(41/502)。CAS后1～、3～、6～、12～、24～36个月累积再狭窄的发生率分别为2.4%、5.9%、9.2%、11.3%和11.3%。COX回归分析显示,高脂血症(OR=2.905,95%CI:1.483～5.694,P=0.002)、术后残余狭窄(OR=3.689,95%CI:1.891～7.197,P=0.000)是影响支架内再狭窄的独立危险因素,而开环式支架是支架内再狭窄的保护因素(OR=0.428,95%CI:0.218～0.842,P=0.014)。结论 CDFI可用于CAS术后再狭窄的评估。使用开环式支架可以降低再狭窄的发生率;术后残余狭窄及高脂血症是再狭窄发生的独立危险因素。

Objectives To detect the incidence of restenosis after carotid artery stenting （CAS） using ultrasound and to analyze its related influencing factors. Methods A total of 485 patients （ 502 stents） treated with CAS in Beijing Xnanwu Hospital, Capital Medical University from January 2008 to June 2012 were enrolled prospectively. The patients were detected by color Doppler flow imaging （CDFI） before the procedure,1 week and 3,6,12,24,36 months after procedure. The changes of carotid arterial hemodynamics and the occurrence of restenosis were evaluated before and after CAS. COX regression analysis was used to analyze the different sonic characteristics, morphology ,types of stent ,the effects of the residual ste- nosis and risk factors of disease on the instent restenosis after procedure. Results The median follow-up time was 24 months （range 1 to 36 months）. The detection rate of in-stent restenosis during the follow-up period was 8.2% （41/502）. The incidences of cumulative restenosis at 1-, 3-,6-, 12-, 24-36 months after CAS were 2.40/0 , 5.9% , 9.2%, 11.3% , and 11.30/0, respectively. COX regression analysis showed that hyperlipidemia （ OR,2. 905,95% CI 1. 483 - 5. 694 ; P = 0. 002 ） and postoperative residual stenosis （OR,3. 689,95% CI 1. 891 -7. 197 ,P = 0. 000） were the independent risk factors for influencing in-stent restenosis, and the open-cell stent was a protective factor of instent restenosis （OR,O. 428,95% CI0. 218-0. 842; P = 0. 014）. Conclusion CDFI can be used to evaluate restenosis after CAS. Using open-cell stents can reduce the incidence of restenosis. The postoperative residual stenosis and hyperlipidemia are the independent risk factors for instent restenosis.