支架辅助肾动脉血管成形术后再次干预后复发性支架内再狭窄的治疗。

Treatment of reoccurring instent restenosis following reintervention after stent-supported renal artery angioplasty.

作者信息

Zeller Thomas, Sixt Sebastian, Rastan Aljoscha, Schwarzwälder Uwe, Müller Christian, Frank Ulrich, Bürgelin Karlheinz, Schwarz Thomas, Hauswald Kirsten, Brantner Regina, Noory Elias, Neumann Franz-Josef

机构信息

Department Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.

出版信息

Catheter Cardiovasc Interv. 2007 Aug 1;70(2):296-300. doi: 10.1002/ccd.21170.

DOI:10.1002/ccd.21170

PMID:17630674

Abstract

BACKGROUND

Reoccurrence of restenosis following angioplasty of renal instent restenosis is a considerable drawback of stent-supported angioplasty of renal artery stenosis especially in small vessel diameters. We therefore prospectively studied the long-term outcome of different techniques of endovascular treatment of reoccurrence of instent renal artery restenosis after primarily successful reangioplasty focusing on the impact of covered and drug eluting stents, respectively.

PATIENTS AND METHODS

The study included 31 consecutive patients (33 lesions) presenting with their at least second instent restenosis following renal artery stenting who were included in a prospective follow-up program (mean follow-up 36+/-25 months, range 1-85). Primary endpoint of the study was the reoccurrence rate of instent stenosis after primarily successful treatment of instent restenosis determined by duplex ultrasound.

RESULTS

Primary success rate was 100%, no major complication occurred. Seven lesions were treated with balloon angioplasty (21%, group 1), 7 lesions with stent-in-stent placement (21%, group 2), 6 lesions with placement of a covered stent (18%, group 3), 3 lesions with a cutting balloon (9%, group 4), and 10 lesions with placement of a drug eluting stent (31%, group 5). During follow-up, overall 12 lesions (36%) developed reoccurrence of instent restenosis: n=5 in group 1 (reoccurrence rate 71%), n=3 in group 2 (43%), n=1 in group3 (17%), 3 in group 4 (100%), and n=0 in group 5 (0%). Treatment with a cutting balloon was the only significant predictor of restenosis (hazard ratio 32.3 (95% CI, 3.3-315.0); P<0.001).

CONCLUSION

Treatment of at least second renal artery instent restenosis is feasible and safe. Balloon angioplasty and the implantation of a bare metal stent, a covered stent, or a drug eluting stent seemed to offer favorable long-term patency, whereas cutting balloon angioplasty resulted in a very high rate of restenoses and should therefore be discouraged for this indication.

摘要

背景

肾动脉支架置入术后再狭窄的复发是肾动脉狭窄支架辅助血管成形术的一个相当大的缺点，尤其是在小血管直径情况下。因此，我们前瞻性地研究了在初次血管成形术成功后，肾动脉支架内再狭窄复发的不同血管内治疗技术的长期结果，分别关注覆膜支架和药物洗脱支架的影响。

患者和方法

该研究纳入了31例连续患者（33处病变），这些患者在肾动脉支架置入术后至少出现第二次支架内再狭窄，并被纳入前瞻性随访计划（平均随访36±25个月，范围1 - 85个月）。研究的主要终点是通过双功超声确定的支架内再狭窄初次成功治疗后支架内狭窄的复发率。

结果

初次成功率为100%，未发生重大并发症。7处病变接受球囊血管成形术治疗（21%，第1组），7处病变接受支架套叠置入术（21%，第2组），6处病变接受覆膜支架置入术（18%，第3组），3处病变接受切割球囊治疗（9%，第4组），10处病变接受药物洗脱支架置入术（31%，第5组）。在随访期间，总体上12处病变（36%）出现支架内再狭窄复发：第1组n = 5（复发率71%），第2组n = 3（43%），第3组n = 1（17%），第4组3处（100%），第5组n = 0（0%）。切割球囊治疗是再狭窄的唯一显著预测因素（风险比32.3（95%CI，3.3 - 315.0）；P < 0.001）。