[1]王　冰　陈　虎　李　江　邓剑平　何宜轩　赵振伟.颅内前循环wingspan支架内再狭窄的危险因素分析[J].中国临床神经外科杂志,2021,26(06):419-421.[doi:10.13798/j.issn.1009-153X.2021.06.005]
　WANG Bing,CHEN Hu,LI Jiang,et al.Risk factors for in-stent restenosis after wingspan stenting in patients with atherosclerotic anterior circulation stenosis[J].,2021,26(06):419-421.[doi:10.13798/j.issn.1009-153X.2021.06.005]
点击复制

颅内前循环wingspan支架内再狭窄的危险因素分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
26
期数:
2021年06期
页码:
419-421
栏目:
论著
出版日期:
2021-06-25

文章信息/Info

Title:
Risk factors for in-stent restenosis after wingspan stenting in patients with atherosclerotic anterior circulation stenosis
文章编号:
1009-153X（2021）06-0419-03
作者:
王　冰　陈　虎　李　江　邓剑平　何宜轩　赵振伟
作者单位：710038 西安，空军军医大学第二附属医院神经外科（王　冰、陈　虎、李　江、邓剑平、何宜轩、赵振伟）
Author(s):
WANG Bing;  CHEN Hu;  LI Jiang;  DENG Jian-ping;  HE Yi-xuan;  ZHAO Zhen-wei.
Department of Neurosurgery, The Second Affiliated Hospital of Air Force Military Medical University, Xi’an 710038, China
关键词:
缺血性脑卒中; 颅内动脉狭窄; 动脉粥样硬化性狭窄; 支架置入术; wingspan支架; 支架内再狭窄; 危险因素
Keywords:
Ischemic stroke;  Intracranial artery stenosis;  Atherosclerotic stenosis;  Stent placement;  Wingspan stent;  In-stent restenosis;  Risk factors
分类号:
R 743.9; R 815.2
DOI:
10.13798/j.issn.1009-153X.2021.06.005
文献标志码:
A
摘要:
目的 探讨颅内前循环动脉粥样硬化性狭窄wingspan支架置入术后支架内再狭窄（ISR）的危险因素。方法 回顾性分析2011年1月至2019年6月winspan支架置入术治疗的99例颅内前循环动脉粥样硬化性狭窄的临床资料。出院后6~12个月复查DSA，ISR定义为：支架附近（5 mm内）狭窄程度超过50%；初始治疗后残留狭窄程度在30%~50%的病例中，绝对管腔直径减少20%。结果 99例共置入wingspan支架100枚，支架成功置入成功率为100%。术后随访6~72个月，中位随访时间12个月（四分位数区间8~19.5个月）。29处（29.0%）发生ISR，71处未发生ISR。多因素logistic回归分析结果显示高血压病史、残留狭窄程度>20%、血脂异常是ISR的独立危险因素（P<0.05）。结论 对于颅内前循环动脉粥样硬化性狭窄病人，支架置入术中注意控制残余狭窄程度，术后应严格控制血脂；对于合并高血压病史的病人，更加要注意危险因素的控制，术后需更为密切的随访和针对性的强化药物治疗。
Abstract:
Objective To analyze the risk factors for in-stent restenosis (ISR) after wingspan stenting in the patients with atherosclerotic anterior circulation stenosis. Methods A retrospective analysis was performed on 99 patients with atherosclerotic anterior circulation stenosis who underwent wingspan stenting from January 2011 to June 2019. Re-examination of DSA was performed 6 to 12 months after discharge. ISR was defined as: the degree of stenosis near the stent (within 5 mm) >50%; the absolute lumen diameter was reduced by 20% in the patients with residual stenosis of 30%~50% after initial treatment. Results A total of 100 stents were placed in these 99 patients, and the surgical success rate was 100%. The postoperative follow-up ranged from 6 months to 72 months, with a median time of 12 months (interquartile range, 8~19.5 months). ISR occurred in 29 stents (29.0%), and no ISR in 71 stents. Multivariate logistic regression analysis showed that a history of hypertension, the degree of residual stenosis>20%, and dyslipidemia were independent risk factors for ISR (P<0.05). Conclusions For patients with atherosclerotic anterior circulation stenosis, the degree of residual stenosis should be strictly controlled during the stent placement, and the level of blood lipids should be strictly controlled after the surgery. For patients with a history of hypertension, more attention should be paid to the control of risk factors and more close follow-up and targeted intensive drug treatment are needed.

参考文献/References:

[1] Campbell BCV, Khatri P. Stroke [J]. Lancet, 2020, 396(10244): 129-142.
[2] Chung JW, Park SH, Kim N, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascularterritory of ischemic stroke lesions diagnosed by diffusion-weighted imaging [J]. J Am Heart Assoc, 2014, 3(4): e001119.
[3] Gr?schel K, Schnaudigel S, Pilgram SM, et al. A systematic review on outcome after stenting for intracranial atheroscle-rosis [J]. Stroke, 2009, 40(5): e340-347.
[4] Samuels OB, Joseph GJ, Lynn MJ, et al. A standardized method for measuring intracranial arterial stenosis [J]. AJNR Am J Neuroradiol, 2000, 21(4): 643-646.
[5] Levy EI, Turk AS, Albuquerque FC, et al. Wingspan in-stent restenosis and thrombosis: incidence, clinical presen-tation, and management [J]. Neurosurgery, 2007, 61(3): 644-650.
[6] Bates ER, Babb JD, Casey DE Jr, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardio-logy Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical ExpertConsensus Document Committee on Carotid Stenting)[J]. J Am Coll Cardiol, 2007, 49(1): 126-170.
[7] Yue X, Xi G, Lu T, et al. Influence of residual stenosis on clinical outcome and restenosis after middle cerebral artery stenting [J]. Cardiovasc Intervent Radiol, 2011, 34(4): 744-750.
[8] Shankar JJ, Zhang J, Dos Santos M, et al. Factors affecting long-term restenosis after carotid stenting for carotid athe-rosclerotic disease [J]. Neuroradiology, 2012, 54(12): 1347-1353.
[9] Wang ZL, Gao BL, Li TX, et al. Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with con-current contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting [J]. Eur J Radiol, 2015, 84(9): 1801-1804.
[10] Zhang L, Huang Q, Zhang Y, et al. A single-center study of Wingspan stents for symptomatic atherosclerotic stenosis of the middle cerebral artery [J]. J Clin Neurosci, 2013, 20(3): 362-366.
[11] Hoffmann R, Mintz GS, Pichard AD, et al. Intimal hyperpla-sia thickness at follow-up is independent of stent size: a serial intravascular ultrasound study [J]. Am J Cardiol, 1998, 82(10): 1168-1172.
[12] Tegos TJ, Kalodiki E, Daskalopoulou SS, et al. Stroke: epidemiology, clinical picture, and risk factors--Part I of III[J]. Angiology, 2000, 51(10): 793-808.
[13] Jimi S, Saku K, Kusaba H, et al. Deposition of oxidized low-density lipoprotein and collagenosis occur coincidentally in human coronary stenosis: an immunohistochemical study of atherectomy [J]. Coron Artery Dis, 1998, 9(9): 551-557.
[14] Kipshidze N, Dangas G, Tsapenko M, et al. Role of theendothelium in modulating neointimal formation: vasculo-protective approaches to attenuate restenosis after percuta-neous coronary interventions [J]. J Am Coll Cardiol, 2004, 44(4): 733-739.
[15] Walsh K, Smith RC, Kim HS. Vascular cell apoptosis inremodeling, restenosis, and plaque rupture [J]. Circ Res, 2000, 87(3): 184-188.
[16] Bennett MR, O’sullivan M. Mechanisms of angioplasty and stent restenosis: implications for design of rational therapy[J]. Pharmacol Ther, 2001, 91(2): 149-166.
[17] Konukoglu D, Uzun H. Endothelial dysfunction and hyper-tension [J]. Adv Exp Med Biol, 2017, 956: 511-540.

相似文献/References:

[1]宋　平　陈晓斌　杜　浩　蔡　强　罗　明　阮　航　吴京雷　段发亮.内膜斑块剥脱术治疗颈动脉狭窄的临床分析[J].中国临床神经外科杂志,2016,(09):527.[doi:10.13798/j.issn.1009-153X.2016.09.006]
　SONG Ping,CHEN Xiao-bin,DU Hao,et al.Clinical analysis of carotid endarterectomy for ischemic stroke[J].,2016,(06):527.[doi:10.13798/j.issn.1009-153X.2016.09.006]
[2]汪晓玲　倪志福　王云甫.依达拉奉联合氯吡格雷治疗老年缺血性脑卒中的效果与安全性分析[J].中国临床神经外科杂志,2017,(04):222.[doi:10.13798/j.issn.1009-153X.2017.04.005]
　WANG Xiao-ling,NI Zhi-fu,WANG Yun-fu..Curative effect of edaravone combined with clopidogrel on ischemic stroke and its safety in the elderly patients[J].,2017,(06):222.[doi:10.13798/j.issn.1009-153X.2017.04.005]
[3]段发亮,黄从刚,倪厚杰,等.阿司匹林联合氯吡格雷治疗缺血性脑卒中的疗效及对血小板聚集率的影响[J].中国临床神经外科杂志,2017,(07):470.[doi:10.13798/j.issn.1009-153X.2017.07.008]
　DUAN Fa-liang,HUANG Cong-gang,NI Hou-jie,et al.Curative effect of aspirin combined with plavix on ischemic stroke and its impact on platelet aggregation rate[J].,2017,(06):470.[doi:10.13798/j.issn.1009-153X.2017.07.008]
[4]王谋龙　李爱红　曲良锁.血清ANP水平及ANP基因多态性与缺血性脑卒中相关性的Meta分析[J].中国临床神经外科杂志,2018,(03):161.[doi:10.13798/j.issn.1009-153X.2018.03.007]
　WANG Mou-long,LI Ai-hong,QU Liang-suo.Meta-analysis of relativity of ANP serum levels and genetic polymorphisms with ischemic stroke risk[J].,2018,(06):161.[doi:10.13798/j.issn.1009-153X.2018.03.007]
[5]徐东为　赵振伟　李　江　闫忠军　屈　延　高国栋.急性前循环脑动脉闭塞支架成形术的疗效[J].中国临床神经外科杂志,2018,(05):328.[doi:10.13798/j.issn.1009-153X.2018.05.008]
　XU Dong-wei,ZHAO Zhen-wei,LI Jiang,et al.Effect of stenting on acute cerebral artery occlusion in anterior circulation[J].,2018,(06):328.[doi:10.13798/j.issn.1009-153X.2018.05.008]
[6]徐　阳　刘宝辉　袁凡恩　刘骏辉　许鹏飞　陈谦学.小胶质细胞在缺血性脑卒中中作用机制的研究进展[J].中国临床神经外科杂志,2018,(07):503.[doi:10.13798/j.issn.1009-153X.2018.07.020]
[7]姚自同,赵文可,黄昌恒,等.颅内前后循环症状性动脉粥样硬化性狭窄血管内治疗的Meta分析[J].中国临床神经外科杂志,2018,(10):665.[doi:10.13798/j.issn.1009-153X.2018.10.008]
　YAO Zi-tong,ZHAO Wen-ke,HUANG Chang-heng,et al.Meta-analysis of the effect of aggressive medical treatment and endovascular interventional therapy on symptomatic intracranial atherosclerotic stenosis in anterior and posterior circulations[J].,2018,(06):665.[doi:10.13798/j.issn.1009-153X.2018.10.008]
[8]秦海林　秦　汉　安学锋　別毕洲.颈动脉内膜斑块剥脱术治疗颈内动脉重度狭窄[J].中国临床神经外科杂志,2018,(12):775.[doi:10.13798/j.issn.1009-153X.2018.12.003]
　QIN Hai-lin,QIN Han,AN Xue-feng,et al.Effect of carotid endarterectomy on patients with severe stenosis of internal carotid artery[J].,2018,(06):775.[doi:10.13798/j.issn.1009-153X.2018.12.003]
[9]杨晓波.基于放松训练的情志护理对缺血性脑卒中病人锻炼依从性的影响[J].中国临床神经外科杂志,2019,(04):242.[doi:10.13798/j.issn.1009-153X.2019.04.019]
[10]陈　玲　赵振伟　张登文　方　伟　樊　霞　翟君丽　郎红娟.目标化康复指导路径表单在脑卒中病人早期康复中的应用[J].中国临床神经外科杂志,2019,(10):631.[doi:10.13798/j.issn.1009-153X.2019.10.018]

备注/Memo

备注/Memo:
通讯作者：赵振伟，E-mail：zzwzc@sina.com
更新日期/Last Update: 2021-06-25