用于确定股浅动脉血管成形术和支架置入术后支架内狭窄的双功超声标准。
Duplex criteria for determination of in-stent stenosis after angioplasty and stenting of the superficial femoral artery.
作者信息
Baril Donald T, Rhee Robert Y, Kim Justine, Makaroun Michel S, Chaer Rabih A, Marone Luke K
机构信息
Department of Surgery, Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
J Vasc Surg. 2009 Jan;49(1):133-8; discussion 139. doi: 10.1016/j.jvs.2008.09.046.
OBJECTIVE
Endovascular intervention is considered first-line therapy for most superficial femoral artery (SFA) occlusive disease. Duplex ultrasound (DU) criteria for SFA in-stent stenosis and correlation with angiographic data remain poorly defined. This study evaluated SFA-specific DU criteria for the assessment of SFA in-stent stenosis.
METHODS
From May 2003 to May 2008, 330 limbs underwent SFA angioplasty and stenting and were monitored by serial DU imaging. Suspected stenotic lesions underwent angiography and intervention when appropriate. Data pairs of DU and angiographically estimated stenosis <or=30 days of each other were analyzed. Seventy-eight limbs met these criteria, and 59 underwent reintervention. In-stent peak systolic velocity (PSV), the ratio of the stented SFA velocity/proximal SFA velocity, changes in ankle-brachial indices (ABIs), and the percentage of angiographic stenosis were examined. Linear regression and receiver operator characteristic (ROC) curve analyses were used to compare angiographic stenosis with PSV and velocity ratios (Vrs) to establish optimal criteria for determining significant in-stent stenosis.
RESULTS
Mean follow-up was 16.9 +/- 8.3 months. Of the 59 limbs that underwent reintervention, 37 (63%) were symptomatic, and 22 (37%) underwent reintervention based on DU findings alone. Linear regression models of PSV and Vr vs degree of angiographic stenosis showed strong adjusted correlation coefficients (R(2) = 0.60, P < .001 and R(2) = 0.55, P < 0.001, respectively). ROC curve analysis showed that to detect a >or=50% in-stent stenosis, a PSV >or=190 had 88% sensitivity, 95% specificity, a 98% positive predictive value (PPV), and a 72% negative predictive value (NPV); for Vr, a ratio of >1.50 had 93% sensitivity, 89% specificity, a 96% PPV, and a 81% NPV. To detect >or=80% in-stent stenosis, a PSV >or=275 had 97% sensitivity, 68% specificity, a 67% PPV, and a 97% NPV; a Vr ratio >or=3.50 had 74% sensitivity, 94% specificity, a 77% PPV, and a 88% NPV. Combining a PSV >or=275 and a Vr >or=3.50 to determine >or=80% in-stent stenosis had 74% sensitivity, 94% specificity, a 88% PPV, and a 85% NPV; odds ratio was 42.17 (95% confidence interval, 10.20-174.36, P < .001) to predict >or=80% in-stent stenosis. A significant drop in ABI (>0.15) correlated with a >62% in-stent stenosis, although the adjusted correlation coefficients was low (R(2) = 0.31, P = .02).
CONCLUSION
PSV and Vr appear to have a significant role in predicting in-stent stenosis. To determine >or=80% stenosis, combining PSV >or=275 cm/s and Vr >or=3.50 is highly specific and predictive.
目的
血管内介入治疗被认为是大多数股浅动脉（SFA）闭塞性疾病的一线治疗方法。关于SFA支架内狭窄的双功超声（DU）标准及其与血管造影数据的相关性仍未明确界定。本研究评估了用于评估SFA支架内狭窄的SFA特异性DU标准。
方法
2003年5月至2008年5月，对330条肢体进行了SFA血管成形术和支架置入术，并通过系列DU成像进行监测。对疑似狭窄病变进行血管造影，并在适当的时候进行干预。分析了DU和血管造影估计的狭窄程度在彼此<或=30天内的数据对。78条肢体符合这些标准，其中59条接受了再次干预。检查了支架内收缩期峰值速度（PSV）、支架置入段SFA速度与近端SFA速度之比、踝肱指数（ABI）变化以及血管造影狭窄百分比。采用线性回归和受试者操作特征（ROC）曲线分析来比较血管造影狭窄与PSV和速度比（Vr），以建立确定显著支架内狭窄的最佳标准。
结果
平均随访时间为16.9±8.3个月。在接受再次干预的59条肢体中，37条（63%）有症状，22条（37%）仅基于DU检查结果接受了再次干预。PSV和Vr与血管造影狭窄程度的线性回归模型显示出很强的校正相关系数（分别为R(2)=0.60，P<.001和R(2)=0.55，P<0.001）。ROC曲线分析表明，要检测支架内狭窄≥50%，PSV≥190时，灵敏度为88%，特异度为95%，阳性预测值（PPV）为98%，阴性预测值（NPV）为72%；对于Vr，比值>1.50时，灵敏度为93%，特异度为89%，PPV为96%，NPV为81%。要检测支架内狭窄≥80%，PSV≥275时，灵敏度为97%，特异度为68%，PPV为67%，NPV为97%；Vr比值≥3.50时，灵敏度为74%，特异度为94%，PPV为77%，NPV为88%。联合使用PSV≥275和Vr≥3.50来确定支架内狭窄≥80%时，灵敏度为74%，特异度为94%，PPV为88%，NPV为85%；预测支架内狭窄≥80%的优势比为42.17（95%置信区间为10.20-174.36，P<.001）。ABI显著下降（>0.15）与支架内狭窄>62%相关，尽管校正相关系数较低（R(2)=0.31，P=.02）。
结论
PSV和Vr在预测支架内狭窄方面似乎具有重要作用。要确定狭窄≥80%，联合使用PSV≥275 cm/s和Vr≥3.50具有高度的特异性和预测性。
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