斑块易损特征对颈动脉支架植入术后再狭窄的影响

Impact of plaque vulnerability features on restenosis after carotid artery stenting

目的观察颈动脉易损斑块特征对颈动脉支架植入术(CAS)后再狭窄的影响。方法纳入117例拟接受单侧CAS的颈动脉狭窄患者,观察术前、术后颈动脉内径及血流动力学变化。术后随访2年,将患者分为再狭窄组(n=18)和无再狭窄组(n=99),比较术前斑块易损特征差异;采用Logistic回归分析评价斑块易损特征对术后再狭窄的影响。结果CAS术后1周,颈动脉内径较术前显著增宽(P<0.05);狭窄处收缩期峰值流速(PSV)及舒张末期流速(EDV)均较术前显著降低(P均<0.05);狭窄远端PSV及EDV均较术前显著提高(P均<0.05)。CAS术后2年内再狭窄率为15.38%(18/117),再狭窄发生时间为术后2~24个月,中位时间7个月;再狭窄组斑块纤维帽不完整及含新生血管征象发生率均高于无再狭窄组(P均<0.05),且均为影响CAS术后发生再狭窄的危险因素(P均<0.05)。结论斑块纤维帽不完整或含新生血管是CAS术后再狭窄的危险因素。

Objective To observe the impact of the features of vulnerable carotid plaques on restenosis after carotid artery stent(CAS).Methods A total of 117 patients with carotid artery stenosis who underwent unilateral CAS were enrolled,and the changes of carotid artery diameter and hemodynamics before and after CAS were evaluated.According to the results of 2-year postoperative following-up,the patients were divided into restenosis group(n=18)and the non-restenosis group(n=99),and the preoperative plaque vulnerability characteristics were compared.Logistic regression analysis was used to evaluate the impact of plaque vulnerability on postoperative restenosis.Results One week after CAS,the diameter of carotid artery was significantly wider than that before CAS(P<0.05),and the peak systolic velocity(PSV)and end-diastolic velocity(EDV)in stenosis segment were all significantly lower than those before operation,while PSV and EDV of distal segment of stenosis were significantly higher than those before operation(all P<0.05).The restenosis rate was 15.38%(18/117)within 2 years after CAS.The time of restenosis ranged from 2 to 24 months(median 7 months).The incidence of incomplete fibrous cap of plaque and neovascular formation in restenosis group were higher than those in non-restenosis group(both P<0.05),and both incomplete fibrous cap of plaque and neovascular formation were risk factors for restenosis after CAS(both P<0.05).Conclusion Incomplete fibrous cap of plaque or neovascularization in plaque were risk factors for restenosis after CAS.