Atar Eli, Avrahami Ram, Koganovich Yuri, Litvin Sergey, Knizhnik Michael, Belenky Alexander
Department of Diagnostic Radiology and Unit of Vascular and Interventional Radiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Isr Med Assoc J. 2009 Oct;11(10):611-4.
Critical limb ischemia is an increasingly common condition that has high surgical morbidity and limited non-surgical options.
To evaluate the use of silicon carbide-coated Motion stents, as compared to reported data for bare metal stents, in elderly patients with infrapopliteal artery stenoses causing critical limb ischemia after failed or complicated percutaneous transluminal angioplasty.
Between January 2003 and March 2004, 41 stents were inserted into 17 consecutive patients (11 males, 6 females, mean age 82 years, range 75-93) following unsuccessful or complicated PTA. Seven patients had one-vessel run-off, six had two-vessel and four had three vessel run-off. All patients suffered from CLI, had up to three lesions and more than one co-morbid condition, and were considered at high surgical risk. Silicon carbide-coated Motion coronary stents, 2.5-4 mm diameterand 25 and 30 mm length, were used. Pre-intervention assessment included clinical condition, ankle brachial index, Doppler ultrasound and digital subtracted angiography. Postintervention evaluation included clinical condition, ABI and Doppler ultrasound at 3, 6 and 12 months.
The technical success rate per lesion was 100% (41/41). Two patients died of unrelated causes after 2 and 8 months respectively. Primary patency rates with duplex ultrasound were 68.7% (11/16) at 3 months, 43.7% (7/16) at 6 months and 40% (6/15) after 12 months. Nine patients developed complete occlusion in 13 stents; three of these patients underwent a below-knee amputation and two patients a partial foot amputation. Re-intervention (PTA only) was performed in 7 patients (43.7%). Secondary patency rate was 81.2% (13/16) at 6 months and 60% (9/15) at one year. Mean ABI index had improved at 6 months from 0.32 to 0.67, and to 0.53 at one year. Clinical improvement was evident in 87.5% (14/16) at 6 months and in 66.6% (10/15) at one year.
Silicon carbide-coated stents are comparable to bare metal stents after 6 and 12 months in infrapopliteal interventions in CLI when stenting is indicated.
严重肢体缺血是一种日益常见的疾病，手术并发症发生率高，非手术治疗选择有限。
与裸金属支架的报道数据相比，评估碳化硅涂层的Motion支架在经皮腔内血管成形术失败或出现并发症后导致严重肢体缺血的腘下动脉狭窄老年患者中的应用。
2003年1月至2004年3月，在经皮腔内血管成形术不成功或出现并发症后，对17例连续患者（11例男性，6例女性，平均年龄82岁，范围75 - 93岁）植入41枚支架。7例患者为单支血管流出道，6例为双支血管，4例为三支血管。所有患者均患有严重肢体缺血，有多达三处病变且合并多种疾病，被认为手术风险高。使用直径2.5 - 4 mm、长度25和30 mm的碳化硅涂层Motion冠状动脉支架。干预前评估包括临床状况、踝肱指数、多普勒超声和数字减影血管造影。干预后评估包括3、6和12个月时的临床状况、踝肱指数和多普勒超声。
每个病变的技术成功率为100%（41/41）。两名患者分别在2个月和8个月后死于无关原因。双功超声检测的初始通畅率在3个月时为68.7%（11/16），6个月时为43.7%（7/16），12个月后为40%（6/15）。9例患者的13枚支架发生完全闭塞；其中3例患者接受了膝下截肢，2例患者接受了部分足部截肢。7例患者（43.7%）进行了再次干预（仅经皮腔内血管成形术）。6个月时的二次通畅率为81.2%（13/16），1年时为60%（9/15）。平均踝肱指数在6个月时从0.32提高到0.67，1年时提高到0.53。6个月时87.5%（14/16）的患者临床症状改善，1年时66.6%（10/15）的患者临床症状改善。
在有指征进行支架置入的严重肢体缺血腘下动脉介入治疗中，6个月和12个月后，碳化硅涂层支架与裸金属支架效果相当。
