颅内动脉粥样硬化性狭窄球囊成形术后血管管腔扩张性重构的相关因素分析

Analysis of related factors for vascular luminal dilatational remodeling after balloon angioplasty for intracranial atherosclerotic stenosis

目的探讨影响颅内动脉粥样硬化性狭窄(ICAS)球囊成形术后血管管腔扩张性重构(VLDR)的相关因素。方法研究采用病例对照方法,分析2019年1月至2022年1月河南省人民医院接受单纯紫杉醇涂层球囊血管成形术(PCBA)或普通球囊血管成形术(POBA)治疗并且完成术后半年随访的症状性ICAS患者,按照随访DSA是否发生VLDR分为VLDR组和非VLDR组,收集患者的基线资料、术前和术后病变特征(DSA)及围手术期相关资料。VLDR定义为在动脉粥样硬化性狭窄患者血管内介入成形术后的影像随访中,病变部位管腔最狭窄处的狭窄率相较于术后即刻狭窄率减少大于10%。采用多因素logistic回归对球囊类型、球囊长度、扩张时间等可能影响VLDR的相关因素进行分析。结果本研究共纳入88例患者,其中VLDR组16例,非VLDR组72例,所有纳入研究的患者随访时间为6.00(5.00,7.00)个月。有18.2%(16/88)病例出现VLDR,PCBA后VLDR发生率为30.4%(14/46),POBA后发生率为4.8%(2/42)。单因素logistic回归分析显示球囊类型、球囊长度、扩张时间、术后即刻狭窄率、随访时间和Mori分型可能会对VLDR发生产生影响,多因素logistic回归分析显示紫杉醇涂层球囊(PCB)的使用(OR=9.82,95%CI 1.99~48.49,P=0.005)和术后即刻狭窄率(OR=1.07,95%CI 1.00~1.14,P=0.042)是VLDR的独立影响因素。结论ICAS球囊血管成形术后VLDR与PCB的使用和术后即刻狭窄率相关,这将对临床中PCB应用提供一定的指导价值。

Objective To explore the factors associated with vascular luminal dilatational remodeling(VLDR)following balloon angioplasty for intracranial atherosclerotic stenosis(ICAS).Methods A case-control study was conducted to analyze the data of symptomatic severe ICAS patients who received either paclitaxel-coated balloon angioplasty(PCBA)or plain balloon angioplasty(POBA)at our center from January 2019 to January 2022 and completed the six-month follow-up.The patients were divided into VLDR group and non-VLDR group according to whether VLDR occurred on follow-up digital subtraction angiography(DSA).The baseline data,preoperative and postoperative lesion characteristics(DSA),and perioperative related information were collected.The definition of VLDR was a decrease in luminal stenosis rate by more than 10%at the time of follow-up compared to the immediate postoperative period.Multivariate logistic regression was performed to analyze possible factors affecting VLDR such as balloon type,balloon length,and expansion time.Results A total of 88 patients were included in this study,with 16 in the VLDR group and 72 in the non-VLDR group.The follow-up time for all included patients was 6.00(5.00,7.00)months.VLDR occurred in 18.2%(16/88)of cases,with a VLDR incidence of 30.4%(14/46)after PCBA and 4.8%(2/42)after POBA.Univariate logistic regression analysis revealed that treatment balloon type,balloon length,inflated time,immediate postoperative stenosis rate,follow-up time and Mori classification may affect the occurrence of VLDR.Multivariate logistic regression analysis showed that the use of paclitaxel-coated balloon(PCB)(OR=9.82,95%CI 1.99-48.49,P=0.005)and postoperative immediate stenosis rate(OR=1.07,95%CI 1.00-1.14,P=0.042)were independently associated with VLDR.ConclusionThe occurrence of VLDR following balloon angioplasty in ICAS was associated with the use of PCB and immediate postoperative stenosis rates,which will provide guidance for the clinical application of PCB.