摘要
目的分析椎动脉起始部支架置入术后再狭窄的发生及影响因素并探讨其规律。方法回顾性分析行椎动脉起始部支架置入术的144例患者的病例资料，按照原治疗部位复发狭窄程度〉50％定义为再狭窄，将病例分成再狭窄组（39例）和未狭窄组（105例）。采用χ2检验分析患者性别、年龄及高血压、糖尿病、冠心病、高脂血症病史，吸烟、饮酒情况，术前后循环供血不足症状、合并其他血管狭窄、置入支架类型及规格与再狭窄的关系，然后行Logistic回归得出结果。结果144例中，椎动脉起始部支架置入术后再狭窄39例（26．4％），均发生在术后5个月内。χ2检验示：未狭窄组和再狭窄组在性别（男89和34例，女16和5例；χ2=0．804，P=0．370）、年龄（≥60岁60和21例；χ2=2．358，P=0．125）、高血压（67和28例；χ2=0．253，P=0．615）、糖尿病（27和9例；χ2=0．914，P=0．91）、冠心病（32和6例；χ2=2．489，P=0．115）、高脂血症（6和5例；χ2=0．478，P=0．489）、吸烟（50和24例；χ2=0．129，P=0．719）、饮酒（20和13例；χ2=0．001，P=0．978）、置人支架直径（≥4mm53和18例；χ2=0．213，P=0．645）及支架长度（≥15mm45和19例；χ2=0．927，P=0．336）、手术前后循环供血不足症状（93和29例；χ2=0．250，P=0．617）上差异无统计学意义（P〉0．05）；未狭窄组和再狭窄组在合并对侧椎动脉狭窄（43和24例；χ2=4．844，P=0．028）、合并颈内动脉狭窄（49和26例；χ2=4．558，P=0．033）、支架类型（药物支架59和11例；χ2=8．916，P=0．003）上差异有统计学意义（P〈0．05）。进行Logistic回归分析显示：使用裸支架和合并颈内动脉狭窄为再狭窄的独立危险因素。结论椎动脉起始部支架置入术后再狭窄多发生于支架置人术后5个月内。合并颈内动脉狭窄和使用裸支架会增加术后再狭窄，术前后循环症状为主和合并对侧椎动脉起始部狭窄可能会增加再狭窄。
Objective To evaluate risk factors of restenosis of vertebral artery origin after stenting. Methods A total of 144 continuous cases were collected for this retrospective analysis. More than 50% of stenosis in the original sites after treatment was defined as restenosis. Patients were divided into restenosis group （39 patients） and none-restenosis group （ 105 patients）. The risk factors associated with restenosis were compared between the two groups by Chi-square test, including sex, age, presence of hypertension, diabetes, coronary heart disease, hyperlipidemia, smoking and drinking, the difference of preoperative neurological symptoms,combination with other vessels, stenosis, as well as stent type and stent size. Logistic regression was used to test the risk factors for restenosis. Results The incidence of restenosis of vertebral artery origin after stenting was 26. 4% , and all of them occurred in 5 months. Between the two groups,there was no significant difference of distribution of sex （male 89, female 34, χ2 = 0. 804, P = 0. 370）, age（ 60 vs 21 patients of more than 60 years old,χ2 = 2. 358, P = 0. 125 ） , hypertension （ 67 vs 28 patients,χ2 =0. 253 ,P =0. 615）,diabetes（27 vs 9 patients,χ2 =0. 914,P =0. 91）,hyperlipidemia（6 vs 5 patients,χ2 = 0. 478, P = 0. 489 ）, coronary heart disease （ 32 vs 6 patients, χ2 = 2. 489, P = 0. 115 ）, smoking （50 vs 24 patients,χ2 =0. 129,P =0. 719 ） ,drinking（20 vs 13 patients,χ2 =0. 001 ,P =0. 978）, diameter of stents （ 53 vs 18 patients of more than 4 mm,χ2=0. 213 ,P =0. 645） ,length of stents （ 45 vs19 patients of more than 15 mm, χ2= 0. 927, P = 0. 336 ） , preoperative neurological symptoms （ 93 vs 29 patients, χ2 = 0. 250, P = 0. 617 ）. There was significant differenee of factors including combination with the bilateral stenosis （43 vs 24 patients,χ2 = 4. 844, P = 0. 028 ） ,eombination with the internal carotid artery stenosis（ 49 vs 26 patients,χ2 =4. 558 ,P =0. 033 ） and stent types（59 vs 11 patients of drug eluting stent, χ2 = 8. 916, P = 0. 003 ） between the two groups. Bare stents and combination with internal carotid artery stenosis were independent risk factors for restenosis by logistic regression. Conclusions The ineidence of restenosis with vertebral artery origin occurs in 5 months after surgery. Bare stents and eombination with internal earotid artery stenosis increased the ineidence of restenosis, and preoperative neurological symptoms of vertebrobasilar system and presence of the bilateral stenosis may induee restenosis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2013年第1期73-76,共4页
Chinese Journal of Radiology
关键词
椎动脉
支架
再狭窄
影响因素
Vertebral artery
Stent
In-stent restenosis
Risk factors
