症状性椎动脉狭窄支架植入术后再狭窄的相关危险因素分析

Analysis of relatedrisk factors of in-stent restenosis after stent implantation for symptomatic vertebral artery stenosis

目的探讨椎动脉狭窄支架植入术后支架内再狭窄(ISRS)的相关危险因素。方法选取2015年6月至2018年9月间在我院接受椎动脉狭窄支架植入术患者110例作为研究组,平均随访15个月,以支架植入段内径狭窄≥50%为再狭窄,分为再狭窄组(33例)和对照组(77例),回顾性分析两组患者的临床资料、生化指标及动脉造影结果的差异,分析其与椎动脉支架内再狭窄的关系。结果通过对可能与ISRS相关的危险因素进行多因素Logistic回归分析显示,ISRS的危险因素有:2型糖尿病(OR=6.392,95%CI 1.361-30.032)、支架长度>13 mm(OR=1.799,95%CI 1.209-2.678)、椎动脉原始内径<3.5 mm(OR=0.069,95%CI 0.013-0.383)、椎动脉起始部变异(OR=7.369,95%CI 1.558-34.860)以及合并多处狭窄病变(OR=8.985,95%CI 1.339-60.290)。结论2型糖尿病、支架长度>13 mm、椎动脉原始内径<3.5 mm、椎动脉起始部变异及合并多处狭窄为预测ISRS发生的主要危险因素,必须更加重视这类危险因素患者的术前评估、随访和复查。

Objective To investigate the related factors of in-stent restenosis(ISRS)after stent implantation for vertebral artery stenosis.Methods Totally 110 patients with vertebral artery stenosis who underwent stent implantation in our hospital from June 2015 to September 2018 were selected as the study group.The mean follow-up period was 15months.When the inner diameter stenosis of implanted segment was more than or equal to 50%,it should be regarded as restenosis.According to this,patients were divided into restenosis group(33 cases)and control group(77 cases).The clinical data,biochemical indexes and angiographic results were analyzed retrospectively in order to explore the relationship between them and ISRS of vertebral artery.Results Multivariate logistic regression analysis showed that the risk factors of ISRS included type 2 diabetes mellitus(OR=6.392,95%CI 1.361-30.032),stent length(>13 mm)(OR=1.799,95%CI 1.209-2.678),primary vascular diameter(<3.5 mm)(OR=0.069,95%CI 0.013-0.383),variation of initial part of vertebral artery(OR=7.369,95%CI 1.558-34.860)and multiple stenosis(OR=8.985,95%CI 1.339-60.290).Conclusion Type 2 diabetes,stent length>13 mm,vascular diameter<3.5 mm,the abnormality of initial part of the vertebral artery and its complication with multiple stenosisare major risk factorsfor predicting ISRS.It is necessary to pay more attention to the preoperative evaluation,follow-up and reexamination of patients with such risk factors.