Rotarex旋切导管在下肢动脉硬化闭塞症支架内再狭窄中的应用

Application of Rotarex mechanical thrombectomy system in treating in-stent restenosis of lower extremity arteriosclerosis obliterans

目的:探讨Rotarex旋切导管在治疗外周动脉疾病(peripheral artery disease,PAD)支架内再狭窄(in-stent restenosis,ISR)中的作用。方法:回顾性分析2017年6月至2018年12月经Rotarex旋切导管治疗的7例下肢PAD ISR患者的临床资料,男性5例,女性2例,年龄59.0~76.0岁,平均(70.0±7.6)岁。患者上次术后下肢缺血症状复发在术后的1.0~72.0个月,中位复发时间6.0个月,自出现缺血症状至本次腔内治疗时间间隔为3 d至2年,中位间隔时间62 d,均行择期再次腔内治疗。再次治疗采用Rotarex机械减容术及经皮血管腔内成形术,必要时再次行支架植入术。术后肝素抗凝24 h,后常规抗血小板治疗,定期彩色超声复查随访。结果:7例ISR患者下肢动脉再通成功,其中3例因原有支架扭曲、断裂再次植入支架,其余4例患者未再植入新的支架。患者术前平均踝肱指数(ankle-brachial index,ABI)为0.31±0.08,术后为0.86±0.08,t=-12.84,P<0.001。住院期间1例因术后支架内急性血栓形成行急诊股动脉切开取栓,术后恢复良好。无其他并发症发生,随访5.0~22.0个月,中位随访时间14.0个月,无死亡及截肢病例。随访期间1例患者因消化道出血停用抗血小板药物,支架内急性血栓形成,3例患者再次出现ISR。结论:使用Rotarex旋切导管减容,可有效减少再次支架植入,但是对于增生内膜及陈旧血栓的减容效果欠佳,且不能解决支架断裂及术后内膜增生等问题,因此还需与药物涂层球囊及支架等手段结合使用。

Objective:To evaluate the role of Rotarex mechanical thrombectomy system in treating instent restenosis of peripheral artery disease(PAD).Methods:The clinical data of 7 in-stent restenosis(ISR)cases of lower extremity PAD from June 2017 to Dec 2018 were retrospectively analyzed.There were 5 males and 2 females and the mean age was(70.0±7.6)years from 59.0 to 76.0 years.All the cases were treated by Rotarex mechanical thrombectomy system.In the 7 cases,time interval from the previous stent implantation to ischemia recurrence was 1.0 to 72.0 months,and the median time was 6.0 months.The period from ischemia recurrence to endovascular therapy was 3 days to 2 years,and the median time was 62 days.Rotarex mechanical debulking catheter and percutaneous transluminal angioplasty(PTA)were used in all the cases,and the stent was used only when it was necessary.Anticoagulation was used for 24 hours after procedures and then antiplatelet agents were used as usual.Doppler ultrasonography was taken during the followed-up.Results:All the 7 cases were successful in technology,3 of which were implanted with new stents for the fracture of the old ones.while for the other four cases,no new stent was implanted.The ankle-brachial index(ABI)increased from 0.31±0.08 to 0.86±0.08 after treatment(t=-12.84,P<0.001).Thrombectomy was applied urgently in one case because of acute thrombosis in the stent,and the result was good.There was no other complications in hospital.All the patients were followed up for 5.0-22.0 months,and the median time was 14.0 months.No death and amputation occurred during the follow-up.One patient stopped antiplatelet agents because of gastrointestinal bleeding,which resulted in acute thrombosis.in-stent restenosis reappeared in 3 cases.Conclusion:Debulking using Rotarex catheter is safe and effective in treating in-stent restenosis of PAD,especially in reducing stents implantation,but is not good at dealing with old thrombus and proliferating intima,and can do nothing about fractured stents and hyperplasia of intima,so it needs to be combined with stents and drug coated balloons.