Gandini Roberto, Del Giudice Costantino, Da Ros Valerio, Sallustio Fabrizio, Altobelli Simone, D'Onofrio Adolfo, Abrignani Sergio, Vasili Erald, Stanzione Paolo, Simonetti Giovanni
1 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, and Radiation Therapy, and the.
J Endovasc Ther. 2014 Oct;21(5):671-7. doi: 10.1583/14-4715MR.1.
To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR).
Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenosis). Of these, 9 patients (7 women; mean age 78.1±5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4±0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter.
Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87%±4% to 6%±4% post treatment. Peak systolic velocity decreased significantly from 4.7±1.5 m/s to 0.6.±0.3 m/s after the procedure. Over a mean follow-up of 36.6±2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months.
DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.
评估紫杉醇洗脱球囊血管成形术治疗复发性颈动脉支架内再狭窄（ISR）的潜在作用、安全性及疗效。
在2002年5月至2008年1月连续接受颈动脉支架置入术的856例患者中，41例存在严重ISR（狭窄>80%）。其中，9例患者（7例女性；平均年龄78.1±5.6岁）在短时间内（2 - 5个月）尽管接受了多次血管内治疗（3.4±0.9次干预）仍出现复发性ISR。这些患者接受了药物洗脱球囊（DEB）血管成形术治疗内膜增生。在术后1、3和6个月以及此后每年进行影像学检查（超声或计算机断层血管造影）。
100%的病例获得技术成功，治疗后血管造影显示狭窄率从87%±4%降至6%±4%。术后收缩期峰值流速从4.7±1.5米/秒显著降至0.6±0.3米/秒。平均随访36.6±2.7个月，超声成像显示仅3例患者分别在DEB血管成形术后18、25和32个月出现复发性ISR。36个月时靶血管再血管化率为33.3%。随访期间未记录到神经或心肌事件。1例患者在3个月时死亡。
DEB可能在改善早期复发性颈动脉ISR患者的治疗结局方面具有潜在作用。
