3DRC及EBU导管介入治疗开口异常肾动脉狭窄的疗效及安全性

Efficacy and safety of interventional therapy with 3DRC and EBU catheters for abnormal renal artery stenosis

目的评价3DRC及EBU导管在开口异常肾动脉狭窄介入治疗中的疗效及安全性。方法回顾性分析2013年2月至2018年4月在中国人民解放军第四七四医院心血管内科治疗的32例肾动脉狭窄患者的临床资料,男性19例,女性13例,年龄56~79岁(平均64.2岁),收缩压(167.3±12.5)mmHg、舒张压(101.9±9.87)mmHg,32例中7例开口异常,应用3DRC及EBU导管介入治疗。结果32例肾动脉狭窄患者均成功完成介入治疗,术后即刻复查造影显示管腔残余狭窄<10%,支架近远端无撕裂及夹层,血流恢复正常。术后复查腹部B超示肾动脉收缩期峰值流速(PSV)术前为(168±3.6)cm/s,术后明显下降至(79±3.1)cm/s,差异有统计学意义(P<0.05);7例开口异常肾动脉狭窄,改用3DRC及EBU导管介入治疗均获成功,无并发症,术后收缩压及舒张压均较术前明显下降[(术前收缩压(167.3±12.7)mmHg,术后(134.6±10.9)mmHg;术前舒张压(101.9±9.8)mmHg,术后(86.4±10.2)mmHg],差异均有统计学意义(P<0.05);服用降压药的种类由术前平均(2.8±1.0)种下降至术后(2.1±0.8)种,差异有统计学意义(P<0.05)。结论肾动脉狭窄的介入治疗有利于血压的控制和达标,减少服药剂量及种类,对于开口异常向上的肾动永狭窄患者,应用3DRC及EBU导管介入治疗安全有效。

Objective To evaluate the efficacy and safety of 3 DRC and EBU catheters in interventional treatment of abnormal renal artery stenosis. Methods The clinical data of 32 patients(19 males and 13 females) with renal artery stenosis treated by cardiovascular medicine in the 474 Hospital of Chinese PLA from February 2013 to April 2018 were enrolled in the study, aged 56-79 years old(mean 64.2 years), with systolic blood pressure(SBP) of(167.3±12.5) mm Hg and diastolic blood pressure(DBP) of(101.9±9.87) mmHg. Seven out of 32 patients with abnormal opening were treated by interventional therapy with 3 DRC and EBU catheters. Results All the 32 patients successfully completed the interventional therapy. Immediate postoperative re-examination and angiography showed that the residual stenosis was less than10%. There was no tear or dissection in the proximal and distal end of the stent, and the blood flow returned to normal.The peak systolic velocity(PSV) of renal artery was significantly decreased by abdominal B-mode ultrasonography on the second postoperative day:(168±3.6) cm/s before operation vs(79±3.1) cm/s after operation, P<0.05). Seven cases of abnormal open renal artery stenosis were successfully treated by interventional therapy with 3 DRC and EBU catheters, without complications. The SBP was(134.6 ± 10.9) mmHg after operation, which was significantly lower than(167.3±12.7) mm Hg before operation. The DBP was(86.4±10.2) mm Hg after operation, significantly lower than(101.9±9.8) mm Hg before operation(P<0.05). The types of antihypertensive drugs decreased from 2.8 ± 1.0 before operation to2.1±0.8 after operation(P<0.05). Conclusion Interventional therapy for renal artery stenosis is conducive to controlling the blood pressure and reaching the target, reducing the dosage and types of medication. For patients with abnormal upward opening of renal artery stenosis, interventional therapy with 3 DRC and EBU catheters is safe and effective.