超声评估锁骨下动脉支架植入术后残余狭窄的影响因素

Evaluation of the influencing factors of residual stenosis after subclavian artery stent placement by ultrasonography

目的探讨超声评估锁骨下动脉支架(SAS)植入术后残余狭窄的发生率及其相关影响因素。方法回顾性纳入2015年5月至2018年4月于首都医科大学宣武医院行SAS植入术的锁骨下动脉重度狭窄(狭窄率≥70%)或闭塞患者,共201例(204枚支架)。所有患者均于术前和术后1个月内行彩色多普勒血流成像(CDFI)检查。数字减影血管造影(DSA)和CDFI显示SAS后狭窄率≥20%定义为残余狭窄。分析锁骨下动脉狭窄与闭塞病变特征、支架类型与长度等对SAS残余狭窄发生率的影响。结果本组204枚支架中有67枚(32.8%)发生SAS≥20%残余狭窄;其中有2枚SAS残余狭窄为≥50%。残余狭窄组与无残余狭窄组患者年龄、性别、动脉硬化危险因素如糖尿病、高血脂、冠心病、吸烟等差异均无统计学意义,但是残余狭窄组高血压患者比例高于无残余狭窄组[68.7%(46/67) vs 48.5%(65/134)],且差异有统计学意义(P=0.007)。残余狭窄组斑块钙化面积≥1/2者所占比例、自膨式支架所占比例、支架原始长度均高于或大于无残余狭窄组[34.3%(23/67)vs 9.5%(13/137),28.4%(19/67) vs 4.4%(6/137),(26.7±7.7)mm vs (23.8±6.3)mm],且差异均有统计学意义(χ~2=19.103,P <0.001;χ2=24.059,P <0.001;t=2.601,P=0.011);残余狭窄组术前SA闭塞者所占比例高于无残余狭窄组,但差异无统计学意义;而两组SA病变长度、病变原始内径、支架原始内径差异无统计学意义。经多因素Logistic回归分析结果显示,斑块钙化程度、支架类型(OR=7.205,95%CI:3.175～16.348,P=0.000;OR=8.591,95%CI:2.825～26.131,P=0.000)均是SAS术后残余狭窄的独立危险因素。结论超声能够准确评价SAS的效果,及时发现残余狭窄,术前斑块钙化面积和支架类型是影响SAS术后残余狭窄的主要因素。

ObjectiveTo investigate the incidence of residual stenosis and its in？uencing factors after subclavian artery stent placement using color Doppler flow imaging （CDFI）. MethodsA total of 201 consecutive patients （204 stents） with severe subclavian artery stenosis （ ≥ 70%） or occlusion who underwent subclavian artery stent （SAS） in our hospital from May 2015 to April 2018 were enrolled. All patients were examined by CDFI within one month before and after surgery. According to the results of digital subtraction angiography （DSA） and CDFI detected, the stenosis≥ 20% after the SAS is dened as in-stent residual stenosis （ISRS）. All of 204 stents were divided into ISRS group （67, 32.8%） and non ISRS group （137, 67.2%）. The characteristics of SA, type and length of stent were analyzed and compared. ResultsThe both groups had no significant differences in age, gender, atherosclerosis risk factors such as diabetes,hyperlipidemia, coronary heart disease, smoking, etc. （P 〉 0.05）, but the proportion of hypertension in the ISRS group was higher relatively （68.7% and 48.5%, P=0.007）. The area of intra-plaque calcication ≥ 1/2 was also much more larger than that in non-ISRS group （34.3% vs 9.5%） （P=0.000）. There was no signi？cantdifference between the length of stenosis and the original diameter of the lesion （P 〉 0.05）. The type of stent in ISRS group was mainly self-expanding stent （P=0.000）, and the original length of stent was longer than that in non-ISRS group （P=0.011）, while the original inner diameter of the stent was no signicant difference between the two groups （P=0.454）. Multivariate Logistic regression analysis showed that the degree of the plaque calcication （OR=7.205, 95%CI： 3.175-16.348, P=0.000）, and stent type （OR=8.591, 95%CI： 2.825-26.131, P=0.000） were independent risk factors for residual stenosis after SAS. ConclusionsUltrasound can accurately evaluate the effect of subclavian artery stent placement, detect residual stenosis in time. Preoperative calci？cation area and stent type are the main factors affecting residual stenosis.