Rotarex减容系统联合药物球囊治疗下肢动脉支架内再狭窄效果分析

Rotarex Thrombectomy Combined with Drug-Coated Balloon for Lower Extremity Artery In-stent Restenosis

目的探究Rotarex减容系统联合药物球囊治疗下肢动脉支架内再狭窄的有效性及安全性。方法选取2018年2月至2021年11月于上海市松江区泗泾医院心血管内科进行治疗的82例支架内再狭窄患者的临床资料进行回顾性分析,其中接受Rotarex减容系统联合药物球囊治疗患者43例(联合治疗组),单纯药物球囊治疗患者39例(单纯球囊治疗组)。术后进行12个月随访,比较2组手术结局,踝肱指数(ABI)和Rutherford分级,以及原发通畅率、免于靶血管血运重建(TVR)率、临床症状改善、血流动力学改善和并发症发生等远期结局指标。结果2组患者均成功完成手术治疗,技术成功率100%;手术前,2组ABI比较差异无统计学意义(P>0.05),术后12个月,联合治疗组ABI明显高于单纯球囊治疗组(P<0.05);手术前,2组Rutherford分级比较差异无统计学意义(P>0.05);术后6个月及12个月,联合治疗组Rutherford分级4和6级例数显著少于单纯球囊治疗组(P<0.05);术后12个月时,联合治疗组免于TVR率显著高于单纯药物球囊治疗组(P=0.0324),而2组血流动力学改善、临床症状改善、并发症发生率比较差异无统计学意义(P>0.05)。结论Rotarex减容系统联合药物球囊治疗下肢动脉支架内再狭窄是安全有效的治疗方案,且在原发通畅率及免于TVR率上均优于单纯药物球囊治疗。

Objective To evaluate the efficacy and safety of Rotarex thrombectomy combined with drug-coated balloon in the treatment of lower extremity artery in-stent restenosis.MethodsClinical data of 82 patients with lower extremity artery in-stent restenosis who received drug-coated balloon angioplasty alone(39 patients) or in combination with Rotarex thrombectomy(43 patients) in department of cardiovascular medicine,Sijing Hospital from February 2018 to November 2021 were retrospectively analyzed.All the patients were followed up for 1 year.Surgical outcomes,ankle brachial index(ABI),Rutherford grade,primary patency rate,freedom from target vessel revascularization(TVR) rate,clinical symptoms,hemodynamics and complications were compared between the two groups.Results All patients successfully completed surgical treatment,with a technical success rate of 100%.There was no significant difference in preoperative ABI between the two groups(P>0.05).However,the ABI in the combined treatment group was higher than that in the balloon treatment group at 12 months after surgery(P<0.05).Before treatment,there was no significant difference in Rutherford grade between the two groups(P>0.05).At 6 months and 12 months after surgery,the numbers of patients with Rutherford grades 4 and 6 in the combined treatment group were lower than those in the balloon treatment group(P<0.05).At 12 months after operation,the freedom from TVR rate in the combined treatment group was higher than that in the balloon treatment group(P=0.032 4).There were no significant differences in hemodynamic improvement,clinical symptom improvement and incidence of complications between the two groups(P>0.05).Conclusion Rotarex thrombectomy combined with drug-coated balloon angioplasty is safe and effective for lower extremity artery in-stent restenosis,and the combination is superior to balloon angioplasty alone in primary patency rate and freedom from TVR rate.