药物球囊在股腘动脉支架内再狭窄中运用的中期随访结果

Medium-term result of drug-coated balloon with paclitaxel in endovascular treatment of femoropopliteal artery in-stent restenosis

目的评价紫杉醇药物涂层球囊(drug-coated balloon,DCB)在股腘动脉支架内再狭窄(in-stent restenosis,ISR)血管腔内治疗中的临床效果。方法对2016年12月至2020年7月接受DCB治疗的股腘动脉ISR患者进行回顾性分析。评价腔内操作的围手术期并发症发生率,术后12、18个月靶血管一期通畅率、一期辅助通畅率、二期通畅率、免于临床症状驱动的靶病变血运重建率(free from clinically-driven target lesion revascularization,F-TLR)、大截肢率以及全因死亡率。结果共52例ISR患者(56条下肢)接受了DCB治疗。根据Rutherford分级:2级1例(1.7%),3级9例(23.2%),4级23例(41.1%),5级15例(26.8%),6级4例(7.1%)。Tosaka Ⅱ级ISR 46条下肢(82.1%),Ⅲ级ISR 10条下肢(17.9%)。平均ISR长度(240±122)mm。一期补救性支架植入率25%。中位随访时间18个月。全因死亡率11.8%、大截肢率为5.9%、一期通畅率53.4%、一期辅助通畅率67.1%、二期通畅率93.2%、F-TLR为77.2%。结论 DCB是一种安全有效的股腘动脉ISR血管腔内治疗手段。

Objective To evaluate the efficacy and safety of drug-coated balloon(DCB)with paclitaxel in the treatment of femoropopliteal artery in-stent restenosis.Methods From Dec 2016 to Jul 2020,clinical and follow-up data of femoropopliteal artery in-stent restenosis(ISR)treated with paclitaxel DCB were retrospectively analyzed.Results Firty-two patients(56 lower limbs)with femoropopliteal artery ISR underwent DCB therapy.According to Rutherford classification,1 case was R2(1.7%),9 cases were R3(23.2%),23 cases were R4(41.1%),15 cases were R5(26.8%)and 4 cases were R6(7.1%).According to Tosaka classification of ISR,46(81.2%)limbs were TosakaⅡ,10(17.9%)limbs were TosakaⅢMean lesion length of ISR was(240±122)mm.Bail-out stent implantation was performed in 25%cases.The median follow-up time was 18 months.The all-cause mortality rate was 11.8%,the major amputation rate was 5.9%,the primary patency rate was 53.4%,the primary assisted patency rate was 67.1%,the secondary patency rate was 93.2%,and the F-TLR was 77.2%.Conclusion DCB is a safe and effective endovascular therapy for femoropopliteal artery ISR.