颈动脉支架置入术后支架断裂和变形的发生率及临床意义。
Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting.
机构信息
Department of Surgery, Division of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
出版信息
J Vasc Surg. 2011 Sep;54(3):685-90. doi: 10.1016/j.jvs.2011.03.257.
OBJECTIVE
Carotid artery stenting (CAS) is a developing intervention for carotid artery stenosis, and long-term outcomes remain unclear. We examined the prevalence and clinical significance of carotid stent fractures or deformations following CAS.
METHODS
Two hundred thirty-one CAS performed in 219 patients at one academic institution between August 2000 and March 2009 were reviewed. One hundred sixteen stents (57 closed cell, 59 open cell) were evaluated with multiplanar plain films of the neck to assess for stent fracture or deformation. Stent fracture was identified by wire strut disruption. Deformation was defined as an increase in stent-cell area from stent strut distortion. Study endpoints included rate of stent fracture or deformation determined using Kaplan-Meier and life table analysis. Factors associated with stent fracture or deformation were identified by Cox regression. Effect of stent fracture or deformation on recurrent carotid artery stenosis >70% requiring reintervention and postoperative stroke was studied.
RESULTS
There were five stent fractures (4%) and 27 deformed stents (23%). Rate of stent fracture or deformation was 15% at 2 years and 50% at 4 years. Deformations were significantly more common in open cell stents than in closed cell stents (58% vs 5% at 4 years, P < .00005). Presence of calcified plaque on plain film was significantly associated with increased rate of stent fracture or deformation (P = .0006). At median follow-up of 25 months, restenosis requiring treatment occurred in four (5%) and late stroke in one (1%). Neither stent fracture nor deformation was associated with late stroke or reintervention.
CONCLUSIONS
Stent fracture and deformation is not uncommon following CAS and is associated with the presence of heavy calcification. Whether a carotid stent fractures or deforms correlates with stent design. Larger studies are necessary to determine the possible clinical significance of carotid stent fracture and deformation.
目的
颈动脉支架置入术（CAS）是一种治疗颈动脉狭窄的新兴介入技术，其长期疗效尚不清楚。本研究旨在探讨 CAS 后颈动脉支架断裂或变形的发生率及其临床意义。
方法
回顾性分析 2000 年 8 月至 2009 年 3 月在一家学术中心接受 231 例颈动脉狭窄患者的 219 例（116 例女性，103 例男性）行 CAS 治疗的患者资料。对 116 枚支架（57 枚密网支架，59 枚开口支架）进行多平面颈部平片检查，以评估支架断裂或变形情况。支架断裂定义为支架丝断裂，支架变形定义为支架单元面积因支架丝扭曲而增加。使用 Kaplan-Meier 和寿命表分析评估支架断裂或变形的发生率。采用 Cox 回归分析确定支架断裂或变形的相关因素。研究支架断裂或变形与再发颈动脉狭窄＞70%需再次干预及术后卒中的关系。
结果
共发现 5 例（4%）支架断裂和 27 例（23%）支架变形。2 年和 4 年时支架断裂或变形的发生率分别为 15%和 50%。4 年时开口支架的变形发生率明显高于密网支架（58%比 5%，P＜0.00005）。平片上有钙化斑块与支架断裂或变形发生率增加显著相关（P=0.0006）。中位随访 25 个月时，4 例（5%）患者因再狭窄需治疗，1 例（1%）患者发生晚期卒中。支架断裂或变形与晚期卒中或再次干预均无相关性。
结论
CAS 后支架断裂和变形并不少见，与严重钙化有关。颈动脉支架断裂或变形与支架设计有关。需要进一步开展大规模研究以确定颈动脉支架断裂和变形的可能临床意义。
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