斑块旋切术联合药物涂层球囊治疗股腘动脉支架内再狭窄效果

Effect of atherectomy combined with drug-coated balloon in treatment of in-stent restenosis of femoropopliteal artery

目的观察TurboHawk旋切系统联合药物涂层球囊(DCB)治疗股腘动脉支架植入术后支架内再狭窄(ISR)的临床效果。方法回顾性分析63例股腘动脉支架植入术后ISR患者,根据手术方式将其分为2组,观察组(n=28)接受TurboHawk旋切联合DCB治疗,对照组(n=35)接受单独DCB治疗,对比2组临床效果及预后。结果63例治疗均获成功,无死亡或截肢病例。术前、术后7天及6个月2组踝肱指数(ABI)差异,术前、术后即刻及6个月靶血管最小管腔直径(MLD)差异均无统计学意义(P均>0.05)。术后12个月观察组ABI、MLD均高于对照组,晚期管腔丢失率(LLL)低于对照组(P均<0.05)。观察组术后3、6、12个月靶血管一期通畅率分别为100%(28/28)、89.29%(25/28)及78.57%(22/28),对照组分别为91.43%(32/35)、71.43%(25/35)及51.43%(18/35),2组术后3、6个月靶血管一期通畅率差异无统计学意义(P均>0.05),术后12个月观察组高于对照组(P=0.028)。结论血管腔内斑块旋切术联合DCB治疗股腘动脉ISR效果较好,近中期效果尤为显著。

Objective To observe the effect of Turbohawk atherectomy combined with percutaneous transluminal angioplasty(PTA)using drug-coated balloon(DCB)for treatment of in-stent restenosis(ISR)after femoropopliteal artery stent implantation.Methods Clinical data of 63 ISR patients after femoropopliteal artery stent implantation were retrospectively analyzed.The patients were divided into 2 groups,those in observation group(n=28)were treated with atherectomy combined with DCB,while in control group(n=35)were treated with DCB alone.The therapeutic effect and prognosis were compared between 2 groups.Results All 63 patients were successfully treated without death nor amputation.There was no significant difference of ankle brachial index(ABI)before procedure,7 days and 6 months after procedure between 2 groups.The difference of minimum lumen diameter(MLD)before procedure,immediately and 6 months after procedure were not statistically significant(all P>0.05).ABI and MLD in the observation group were higher than those in control group 12 months after procedure,while the rate of late lumen loss(LLL)was lower than that in control group(both P<0.05).The primary patency rate of the target vessel in observation group was 100%(28/28),89.29%(25/28)and 78.57%(22/28)for 3,6 and 12 months after procedure,respectively,while in control group was 91.43%(32/35),71.43%(25/35)and 51.43%(18/35),respectively.No significant difference of primary patency rate was found between 2 groups 3 and 6 months after procedure(both P>0.05),while primary patency rate of observation group was higher than that of control group 12 months after procedure(P=0.028).Conclusion Atherectomy combined with DCB is effective in treatment of femoropopliteal artery ISR,especially in the near and middle terms.