N'Dandu Zola M, Badawi Ramy A, White Christopher J, Grise Mark A, Reilly John P, Jenkins J Stephen, Collins Tyrone J, Ramee Stephen R
Department of Cardiovascular Diseases, The Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
Catheter Cardiovasc Interv. 2008 Apr 1;71(5):701-5. doi: 10.1002/ccd.21509.
We investigated whether repeat renal artery stent placement compared with treatment with balloon angioplasty alone results in better patency in patients presenting with renal artery in-stent restenosis (ISR).
Although stent placement for renal artery stenosis has been demonstrated to be superior to balloon angioplasty for "de novo" renal artery lesions, the optimal therapy for ISR remains unclear.
Between January 1997 and August 2006, 34 consecutive patients (41 renal arteries) with ISR were treated at the discretion of the operator with balloon angioplasty or repeat stent placement. Quantitative angiography was performed before and immediately after intervention and at follow-up. Angiographic follow-up was obtained for clinical indications in 75% of lesions and routine noninvasive follow-up imaging was obtained in 95% of lesions.
Repeat renal artery stent placement demonstrated improved patency compared with balloon angioplasty alone with a 58% reduction in recurrent ISR (29.4% vs. 71.4%, P = 0.02) and a 30% reduction in follow-up diameter stenosis (41% vs. 58.2%, P = 0.03). The repeat stent group also had better secondary patency (P = 0.05) and a greater freedom from repeat ISR (P = 0.01) when compared with balloon angioplasty alone. There was a trend favoring repeat stent placement for cumulative freedom from target vessel revascularization (TVR) (P = 0.08).
Repeat stent placement appears to result in superior patency compared with balloon angioplasty alone for the treatment of renal ISR.
我们研究了与单纯球囊血管成形术相比，重复肾动脉支架置入术是否能使肾动脉支架内再狭窄（ISR）患者获得更好的通畅率。
虽然肾动脉狭窄的支架置入术已被证明在治疗“初发”肾动脉病变方面优于球囊血管成形术，但ISR的最佳治疗方法仍不明确。
在1997年1月至2006年8月期间，34例连续的ISR患者（41条肾动脉）由操作者酌情采用球囊血管成形术或重复支架置入术进行治疗。在干预前、干预后即刻以及随访时进行定量血管造影。75%的病变进行了血管造影随访以评估临床指征，95%的病变进行了常规无创随访成像。
与单纯球囊血管成形术相比，重复肾动脉支架置入术显示出更好的通畅率，复发性ISR降低了58%（29.4%对71.4%，P = 0.02），随访时直径狭窄降低了30%（41%对58.2%，P = 0.03）。与单纯球囊血管成形术相比，重复支架组的二级通畅率也更好（P = 0.05），再次发生ISR的自由度更高（P = 0.01）。在免于靶血管再血管化（TVR）的累积自由度方面，有倾向于重复支架置入术的趋势（P = 0.08）。
对于肾ISR的治疗，与单纯球囊血管成形术相比，重复支架置入术似乎能带来更好的通畅率。
