Iida Osamu, Nanto Shinsuke, Uematsu Masaaki, Ikeoka Kuniyasu, Okamoto Shin, Nagata Seiki
Kansai Rosai Hospital, Hyogo, Japan.
JACC Cardiovasc Interv. 2009 Jul;2(7):665-71. doi: 10.1016/j.jcin.2009.04.014.
We investigated the time course of stent patency in the femoro-popliteal artery for as long as 4 years.
Stent fracture has been related to poor 2-year patency in the femoro-popliteal artery.
We studied 239 consecutive patients who underwent provisional de novo stenting with nitinol stents for 333 limbs (Luminexx stent [C. R. Bard, Inc., Murray Hill, New Jersey] in 91 limbs; Smart stent [Cordis Corp., Miami Lakes, Florida] in 242 limbs) from April 2004 to December 2007. Stent fracture was determined by X-ray with multiple projections. Patency was assessed by duplex ultrasonography as peak systolic velocity ratio <2.4 or by angiography (% diameter stenosis <50%). Primary patency in those with and without stent fracture at follow-up was assessed along with factors influencing stent fracture.
Primary patency was 81%, 74%, 68%, and 65% at 1, 2, 3, and 4 years, respectively. Stent fracture occurred in 14% (78 of 544) per stent and 17% (55 of 333) per limbs. Stent fracture was significantly associated with multiple stent deployments (with fracture = 2.3 +/- 0.9 stents vs. without fracture = 1.5 +/- 0.7 stents, p < 0.001) and long lesions (with fracture = 208 +/- 84 mm vs. without fracture = 121 +/- 79 mm, p < 0.001). Primary patency was 68% with fracture versus 83% without fracture at 1 year, p = 0.03; 65% versus 75% at 2 years, p = 0.05; 61% versus 69% at 3 years, p = 0.06; and 61% versus 65% at 4 years, p = 0.07. Neither type 1 nor type 3 fracture affected patency, although type 2 showed the worst patency.
Stent fracture worsened the patency during the first 2 years, but it did not apparently affect patency beyond 2 years. In particular, complete stent separation did not affect patency.
我们研究了股腘动脉支架通畅的时间进程，长达4年。
支架断裂与股腘动脉2年通畅率不佳有关。
我们研究了239例连续患者，这些患者在2004年4月至2007年12月期间接受了用镍钛诺支架进行的初次临时支架置入术，共涉及333条肢体（91条肢体使用Luminexx支架[C.R. Bard公司，新泽西州默里山]；242条肢体使用Smart支架[Cordis公司，佛罗里达州迈阿密湖]）。通过多投照X线确定支架断裂情况。通过双功超声检查评估通畅情况，即收缩期峰值流速比<2.4，或通过血管造影评估（直径狭窄百分比<50%）。评估随访时有无支架断裂患者的初始通畅情况以及影响支架断裂的因素。
1年、2年、3年和4年时的初始通畅率分别为81%、74%、68%和65%。每个支架的断裂发生率为14%（544个支架中的78个），每条肢体的断裂发生率为17%（333条肢体中的55条）。支架断裂与多次支架置入（有断裂=2.3±0.9个支架，无断裂=1.5±0.7个支架，p<0.001）和长病变（有断裂=208±84毫米，无断裂=121±79毫米，p<0.001）显著相关。1年时，有断裂患者的初始通畅率为68%，无断裂患者为83%，p=0.03；2年时分别为65%和75%，p=0.05；3年时分别为61%和69%，p=0.06；4年时分别为61%和65%，p=0.07。1型和3型骨折均不影响通畅情况，尽管2型骨折的通畅情况最差。
支架断裂在最初2年内使通畅情况恶化，但在2年后显然并未影响通畅情况。特别是，支架完全分离并不影响通畅情况。
