ViabahnTM覆膜支架治疗动脉粥样硬化性肾动脉狭窄的临床疗效

Clinical Efficacy of ViabahnTM Covered Stent in the Treatment of Atherosclerotic Renal Artery Stenosis

目的探讨ViabahnTM覆膜支架治疗动脉粥样硬化性肾动脉狭窄的可行性、安全性及有效性。方法搜集2015年1月至2017年3月在郑州大学第一附属医院使用ViabahnTM覆膜支架治疗的肾动脉狭窄患者27例。回顾性分析患者的基线资料和介入治疗情况,并进行临床随访,主要终点为被治疗血管在术后12个月的主要通畅率,次要终点包括临床成功、不良事件率、血压及肾功能变化情况。结果 27例患者成功置入30枚ViabahnTM覆膜支架,病变处管腔狭窄程度从(81.67±8.43)%降至(5.9±6.2)%,实现了解剖学及血流动力学成功,技术成功率100%;术后24 h及术后3、6、12个月,患者收缩压/舒张压分别为(182.22±13.75)mmHg/(121.56±15.32)mmHg、(130.41±16.96)mmHg/(92.70±8.73)mmHg、(136.93±10.07)mmHg/(89.81±6.40)mmHg、(135.44±8.81)mmHg/(93.37±10.18)mmHg,较术前(188.74±15.70)mmHg/(123.78±15.15)mmHg,术后24 h收缩压、舒张压无明显下降趋势,差异无统计学意义(P>0.05);支架置入术后3、6、12个月,患者的收缩压、舒张压呈下降趋势,差异均有统计学意义(P<0.01);血肌酐(Scr)分别为(173.19±16.10)μmol/L、(171.22±14.71)μmol/L、(168.63±14.83)μmol/L、(169.78±18.01)μmol/l,较术前(173.67±18.31)μmol/L有轻度下降,差异均无统计学意义(P>0.05)。肾小球滤过率(GFR)分别为(34.52±9.34)ml/min、(34.48±9.28)ml/min、(34.67±8.93)ml/min、(33.96±8.76)ml/min,较术前(27.07±8.23)ml/min有升高趋势,差异均有统计学意义(P<0.01)。肾动脉峰值流速(PSV)分别为(78.56±4.75)cm/s、(88.63±4.80)cm/s、(88.15±4.77)cm/s、(90.04±4.10)cm/s,较术前(164.78±24.79)cm/s,差异均有统计学意义(P<0.01)。患侧肾动脉阻力指数(RI)分别为0.28±0.05、0.31±0.05、0.33±0.06、0.34±0.07,较术前0.81±0.09动脉阻力指数下降,差异均有统计学意义(P<0.01)。术后3、6、12个月行双功能彩色多普勒超声检查,无明显肾动脉PSV≥200 cm/s及RI升高,血管通畅率为100%。结论 ViabahnTM覆膜支架治疗动脉粥样硬化性肾动脉狭窄安全、可靠,近期疗效显著,可作为动脉粥样硬化性肾动脉狭窄血管重组的有效方法。

Objective To investigate the feasibility,safety and efficacy of ViabahnTM stent graft in the treatment of atherosclerotic renal artery stenosis.Methods From January 2015 to March 2017,27 patients with renal artery stenosis who had ViabahnTM stent placement in the First Affiliated Hospital of Zhengzhou University were enrolled in this study.The cilinical data was retrospectively analyzed and clinical follow-up was done.The primary endpoint was the patency rate of the treated artery at 12 months.The secondary endpoints included clinical success,adverse event rate,blood pressure and renal function changes.Results 27 patients with atherosclerotic renal artery stenosis were successfully implanted with 30 ViabahnTM stents with a technical success rate of 100%;After operation,The stenosis of the lesion was reduced from(81.67%±8.43%)to(5.9%±6.2%),achieving anatomical and hemodynamic success.24 hours and 3,6 and 12 months after operation,the systolic/diastolic pressure of patients were(182.22±13.75)/(121.56±15.32),(130.41±16.96)/(92.70±8.73),(136.93±10.07)/(89.81±6.40),(135.44±8.81)/(93.37±10.18)mmHg,compared with preoperative(188.74±15.70)/(123.78±15.15)mmHg.The systolic pressure and diastolic pressure 24 hours after operation did not have a significantly declining trend,the difference is not statistically significant(P>0.05).During 3,6 and 12 months after stent implantation,the systolic and diastolic pressure of patients showed a decreasing trend(P<0.01),and the difference was statistically significant.The blood creatinine(Scr)were(173.19±16.10),(171.22±14.71),(168.63±14.83),(169.78±18.01)μmol/l,slightly lower than preoperative(173.67±18.31)μmol/L None of the differences were statistically significant(P>0.05).The glomerular filtration rate(GFR)was(34.52±9.34),(34.48±9.28),(34.67±8.93),(33.96±8.76)ml/min,which was significantly higher than that of preoperative(27.07±8.23)ml/min,and the difference was statistically significant(P<0.01).The peak velocity of renal artery(PSV)was(78.56±4.75),(88.63±4.80),(88.15±4.77),(90.04±4.10)cm/s,compared with preoperative(164.78±24.79)cm/s;the difference was statistically significant(P<0.01).The affected lateral renal artery resistive Index(RI)was(0.28±0.05),(0.31±0.05),(0.33±0.06),(0.34±0.07),and the difference was statistically significant compared with the decrease of preoperative 0.81±0.09 arterial resistive Index(P<0.01).At 3,6 and 12 months postoperative on the monthly double-function color Doppler examination,there was no obvious renal artery PSV≥200 cm/s and RI increased,and the vascular patency rate was 100%.Conclusion The placement of ViabahnTM stent for atherosclerotic renal artery stenosis is a safe and feasible method which has a short-term efficacy and can become one of the methods of vascular reconstruction in patients with sclerosing renal artery stenosis.