CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes F-44000, France.
Eur J Vasc Endovasc Surg. 2013 Aug;46(2):201-12. doi: 10.1016/j.ejvs.2013.05.010. Epub 2013 Jun 15.
The clinical impact of stent fractures is still controversial. This study analyzed the incidence and the clinical impact of stent fractures after stenting of long femoropopliteal lesions.
From November 2008 to October 2009, 58 patients (62 limbs) were treated in a single center with a primary nitinol self-expanding stent for Trans-Atlantic Inter-Consensus (TASC) C and D de novo femoropopliteal lesions. Patients were prospectively followed by medical and duplex scan examinations. Stent fractures were assessed by biplane X-rays at 12 months. Logistic regression analysis was performed.
At 1 year a complete follow-up was obtained in 42 limbs/90 stents. The median length of the stented segment was 240 ± 180 cm with a mean of 2.1 (1-4) stents per patient. Sixteen stents (17.8%) were fractured: one type I (asymptomatic); seven type II (2 restenosis); five type III (asymptomatic), and three type IV stent fractures (1 restenosis). Stent diameter (p = .04) and stent implantation in the distal part of the superficial femoral artery (p = .05) were positively associated with stent fractures. Stent fracture had no influence on restenosis.
This study suggests that the high stent fracture rate associated with endovascular treatment of long femoropopliteal lesions should be balanced with its low clinical impact.
支架断裂的临床影响仍存在争议。本研究分析了长段股腘动脉病变支架置入后支架断裂的发生率和临床影响。
2008 年 11 月至 2009 年 10 月，58 例（62 条肢体）在一家中心接受初次镍钛诺自膨式支架置入治疗 Trans-Atlantic Inter-Consensus（TASC）C 和 D 型原发股腘动脉病变。患者前瞻性地接受了医学和双功能超声检查随访。12 个月时通过双平面 X 射线评估支架断裂情况。采用逻辑回归分析。
1 年时，42 条肢体/90 个支架获得完全随访。支架置入段的中位长度为 240±180cm，平均每位患者置入 2.1（1-4）个支架。16 个支架（17.8%）发生断裂：1 型（无症状）1 个；2 型（再狭窄）7 个；3 型（无症状）5 个；4 型支架断裂 3 个（再狭窄 1 个）。支架直径（p=.04）和支架在股浅动脉远端植入（p=.05）与支架断裂呈正相关。支架断裂对再狭窄无影响。
本研究提示，长段股腘动脉病变血管内治疗后较高的支架断裂率应与其较低的临床影响相平衡。
