Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, China.
J Clin Neurosci. 2013 Jan;20(1):122-7. doi: 10.1016/j.jocn.2012.01.051. Epub 2012 Nov 5.
Covered stent placement has emerged as a promising therapeutic option for intracranial vascular lesions. However, in-stent stenosis and occlusion continue to be important concerns with the use of a covered stent, which is more thrombogenic than other types of stents. The purpose of this study was to determine predictors of in-stent stenosis and occlusion for covered stents used in the treatment of intracranial vascular diseases. Clinical, procedural and angiographic data of 46 patients with 49 intracranial vascular lesions treated with the Willis covered stent (Micro-Port, Shanghai, China) between April 2005 and October 2010 were collected and analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were performed to determine the factors predictive of in-stent stenosis and/or occlusion of the stents. In-stent stenosis and/or occlusion were documented at angiography in six patients with six lesions, and no stenoses or occlusions were seen at angiography in the remaining 40 patients with 43 lesions. Univariate analysis revealed that hypertension, post-procedure irregular antiplatelet therapy and cerebrovascular arteriosclerosis were associated with in-stent stenosis and/or occlusion. By multivariate logistic regression analysis, post-procedure irregular antiplatelet therapy (odds ratio [OR]=15; 95% confidence interval [CI], 1.172-192.004; p=0.037) and cerebrovascular arteriosclerosis (OR=19; 95% CI, 1.374-262.659; p=0.028) were independent predictors of in-stent stenosis and/or occlusion. Thus, post-procedure irregular antiplatelet therapy and coexistent cerebrovascular arteriosclerosis appear to increase the risk of in-stent stenosis and/or occlusion of covered stents in the treatment of intracranial vascular disease.
覆膜支架置入术已成为治疗颅内血管病变的一种有前途的治疗选择。然而，与其他类型的支架相比，覆膜支架的血栓形成率更高，因此支架内狭窄和闭塞仍然是使用覆膜支架的重要关注点。本研究旨在确定覆膜支架治疗颅内血管疾病的支架内狭窄和闭塞的预测因素。回顾性收集 2005 年 4 月至 2010 年 10 月期间使用 Willis 覆膜支架（上海微创医疗器械有限公司）治疗的 46 例 49 处颅内血管病变患者的临床、手术和血管造影资料。进行单因素分析和多因素 logistic 回归分析，以确定支架内狭窄和/或闭塞的预测因素。6 例 6 处病变的血管造影显示支架内狭窄和/或闭塞，40 例 43 处病变的血管造影未见狭窄或闭塞。单因素分析显示，高血压、术后不规则抗血小板治疗和脑血管动脉硬化与支架内狭窄和/或闭塞有关。多因素 logistic 回归分析显示，术后不规则抗血小板治疗（比值比[OR]=15；95%置信区间[CI]，1.172-192.004；p=0.037）和脑血管动脉硬化（OR=19；95%CI，1.374-262.659；p=0.028）是支架内狭窄和/或闭塞的独立预测因素。因此，术后不规则抗血小板治疗和并存的脑血管动脉硬化似乎会增加覆膜支架治疗颅内血管疾病时支架内狭窄和/或闭塞的风险。
