定向斑块旋切系统在股腘动脉支架内再狭窄治疗中的应用效果

Effect of directional atherectomy system in treatment of femoropopliteal artery in-stent restenosis

目的探讨定向斑块旋切系统治疗股腘动脉支架内再狭窄(ISR)的有效性及安全性。方法选取2016年7月至2021年9月于中山大学附属第一医院使用定向斑块旋切系统治疗的10例股腘动脉ISR患者。观察患者的围手术期情况及临床症状缓解情况;记录患者的手术成功率、技术成功率及一期通畅率;随访患者的临床症状缓解情况及不良事件发生情况。结果10例股腘动脉ISR患者全部血运重建成功,手术成功率为100%。在无其他介入治疗手段的辅助下,单纯运用定向斑块旋切系统开通靶病变的技术成功率为60%。支架植入率为40%,药物涂层球囊的使用率为50%。患者的术后踝肱指数(ABI)明显高于术前,差异有统计学意义(P<0.01)。7例患者的术后临床症状较术前明显改善。术后1、2年的一期通畅率分别为85.7%、57.1%。3例患者术中出现不良事件,其中1例患者出现刀头卡陷,导致支架断裂和胫腓干栓塞;2例患者出现支架切割,普通球囊扩张成形术后支架形态未发生明显异常改变,造影检查结果显示血流通畅,无需处理。结论定向斑块旋切系统治疗股腘动脉ISR效果确切,会发生一定的不良事件,但通常不造成严重后果,早期通畅率较好。

Objective To evaluate the efficacy and safety of a directional atherectomy system in treatment of femoropopliteal artery in-stent restenosis(ISR).Method Clinical data of 10 patients with femoropopliteal artery ISR underwent directional atherectomy system from July 2016 to September 2021 in the First Affiliated Hospital,Sun Yatsen University was collected.The perioperative parameters and recovery of clinical symptoms were observed,surgical success rate,technical success rate and primary patency rate were recorded,complications and recovery of clinical symptoms were followed up.Result A total of 10 patients with femoropopliteal artery ISR all achieved revascularization with 100% of surgical success rate.Without other assisted-intervention,the technical success rate of recanalization of target lesions with directional atherectomy system alone was 60%,the stent implantation rate was 40%,and the utilization rate of drug-coated balloon was 50%.Postoperative ankle brachial index(ABI)was significantly higher than that before operation,and the difference was statistically significant(P<0.01).Postoperative symptoms of 7 patients improved significantly.The postoperative primary patency rate in the first year was 85.7%,the second year was 57.1%.During the operation,3 patients developed adverse events,cutter head of 1 patient struck,leading to stent break and tibiofibular artery embolism;2 patients experienced cutting of the stent,however,there was no significant change of stent after balloon angioplasty and no actions need to be taken with angiography showing patent blood flow.Conclusion The directional atherectomy system is effective for the treatment of femoropopliteal artery ISR,with a risk of adverse events that rarely cause severe complications,and the short-term patency is satisfactory.