重度有症状颅内段颈动脉狭窄患者支架内再狭窄的危险因素

Risk factors for in-stent restenosis in patients with severe symptomatic intracranial carotid stenosis

目的探讨重度有症状颅内段颈动脉狭窄患者经皮血管成形支架置入术(percutaneous transluminal angioplasty and stenting,PTAS)后支架内再狭窄(in-stent restenosis,ISR)的危险因素。方法回顾性连续纳入2021年12月至2023年6月在济宁市第一人民医院神经内科接受PTAS的重度有症状颅内段颈动脉狭窄患者。收集患者临床和手术相关资料,记录围手术期并发症。6个月后影像学随访评估ISR。应用多变量logistic回归分析确定ISR的独立危险因素。结果共纳入73例患者,男性45例(61.6%),年龄(61.49±7.78)岁。中位随访时间为8个月(四分位数间距:7~9个月;范围:6~10个月),19例(26.0%)发生ISR,其中1例(1.4%)为有症状ISR。多变量logistic回归分析显示,术后即刻残余狭窄程度较高[优势比(odds ratio,OR)1.102,95%置信区间(confidence interval,CI)1.004~1.209;P=0.040]、伴其他部位脑血管中度以上狭窄(OR 6.638,95%CI 1.106~39.835;P=0.038)和术前白细胞计数较低(OR 0.541,95%CI 0.308~0.952;P=0.033)为ISR的独立危险因素。结论术后即刻残余狭窄程度较高、伴其他部位脑血管中度以上狭窄和术前血白细胞计数较低是重度颅内段颈动脉狭窄患者PTAS术后发生ISR的危险因素。

ObjectiveTo investigate risk factors for in-stent restenosis(ISR)after percutaneous transluminal angioplasty and stenting(PTAS)in patients with severe symptomatic intracranial carotid stenosis.MethodsConsecutive patients with severe symptomatic intracranial carotid stenosis underwent PTAS in the Department of Neurology,Jining First People's Hospital from December 2021 to June 2023 were retrospectively included.Clinical and procedure related data were collected,and periprocedural complications were recorded.Imaging follow-up was used to evaluate ISR after 6 months.Multivariate logistic regression analysis was used to determine independent risk factors for ISR.ResultsA total of 73 patients were enroled,including 45 males(61.6%),aged 61.49±7.78 years.The median follow-up time was 8 months(interquartile range,7-9 months;range,6-10 months),with 19 cases(26.0%)experiencing ISR,of which 1(1.4%)had symptomatic ISR.Multivariate logistic regression analysis showed that the higher degree of residual stenosis immediately after procedure(odds ratio[OR]1.102,95%confidence interval[CI]1.004-1.209;P=0.040),accompanied by moderate to severe cerebrovascular stenosis in other areas(OR 6.638,95%CI 1.106-39.835;P=0.038)and low preprocedural white blood cell count(OR 0.541,95%CI 0.308-0.952;P=0.033)were the independent risk factors for ISR.ConclusionThe higher degree of residual stenosis immediately after procedure,accompanied by moderate to severe cerebrovascular stenosis in other areas,and lower preprocedural white blood cell count are the risk factors for the occurrence of ISR after PTAS in patients with severe intracranial carotid stenosis.