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目的应用超声检测颈动脉支架置入术(CAS)后再狭窄的发生率,并分析其相关影响因素。方法前瞻性纳入2008年1月—2012年6月在首都医科大学宣武医院行CAS治疗的患者485例(502枚支架)。于术前,术后1周,术后3、6、12、24、36个月行彩色多普勒血流成像(CDFI)检测,评估CAS术前、术后颈动脉血流动力学变化及再狭窄发生情况。应用COX回归分析支架置入术前动脉粥样硬化斑块的不同声波特征、形态,置入的支架类型(开环式或闭环式),术后残余狭窄及疾病危险因素对CAS后支架内再狭窄的影响。结果随访中位数时间为24个月(1～36个月),随访期间支架再狭窄的检出率为8.2%(41/502)。CAS后1～、3～、6～、12～、24～36个月累积再狭窄的发生率分别为2.4%、5.9%、9.2%、11.3%和11.3%。COX回归分析显示,高脂血症(OR=2.905,95%CI:1.483～5.694,P=0.002)、术后残余狭窄(OR=3.689,95%CI:1.891～7.197,P=0.000)是影响支架内再狭窄的独立危险因素,而开环式支架是支架内再狭窄的保护因素(OR=0.428,95%CI:0.218～0.842,P=0.014)。结论 CDFI可用于CAS术后再狭窄的评估。使用开环式支架可以降低再狭窄的发生率;术后残余狭窄及高脂血症是再狭窄发生的独立危险因素。
Objective To detect the incidence of restenosis after carotid stenting (CAS) with ultrasound and analyze the related factors. Methods Forty-five patients (502 stents) with CAS were enrolled in the Xuanwu Hospital of Capital Medical University from January 2008 to June 2012. Color Doppler flow imaging (CDFI) was performed preoperatively, 1 week after surgery and 3,6,12,24,36 months after surgery to evaluate the changes of carotid hemodynamics before and after CAS and Restenosis occurs. COX regression was used to analyze the different sonic characteristics and morphology of the atherosclerotic plaques before stent implantation, the type of stent (open loop or closed loop), postoperative residual stenosis and disease risk factors. Narrow impact. Results The median follow-up time was 24 months (range 1-36 months). The rate of stent restenosis during follow-up was 8.2% (41/502). The incidences of cumulative restenosis were 2.4%, 5.9%, 9.2%, 11.3% and 11.3% at 1, 3, 6, 12 and 24-36 months after CAS, respectively. COX regression analysis showed that postoperative residual stenosis (OR = 3.689, 95% CI: 1.891-7.197, P = 0.000) was associated with hyperlipidemia (OR = 2.905,95% CI: 1.483-5.694, P = 0.002) Stent open-bracket was an independent risk factor for in-stent restenosis (OR = 0.428, 95% CI: 0.218-0.842, P = 0.014). Conclusion CDFI can be used for the evaluation of restenosis after CAS. The use of open-loop stents can reduce the incidence of restenosis; postoperative residual stenosis and hyperlipidemia are independent risk factors for restenosis.