Kaladji Adrien, Giovannetti Maximilien, Pascot Remy, Clochard Elodie, Daoudal Anne, Lucas Antoine, Cardon Alain
1 CHU Rennes, Centre of Cardiothoracic and Vascular Surgery, Rennes, France.
2 INSERM, Rennes, France.
Vascular. 2017 Oct;25(5):504-513. doi: 10.1177/1708538117700764. Epub 2017 Mar 22.
Objectives This study evaluates the effect of stent sizing with CT-scan on the incidence of restenosis in peripheral arterial disease. Methods This retrospective study included 59 patients with 66 arterial lesions who underwent a endovascular procedure for peripheral arterial disease between April 2013 and October 2013. All patients had de novo iliac or femoral lesions, were candidates for an endovascular procedure alone and underwent CTA preoperatively. The stent actually implanted, whose dimensions were chosen on the basis of the operator's experience on an intraoperative 2D angiography, was compared to the "ideal" stent chosen retrospectively on the basis of precise lesion sizing by the preoperative CTA. Planning was considered "discordant" if there was a difference in length of more than 20 mm and/or a difference in diameter of more than 1 mm between the ideal stent and the actual stent. Results For iliac lesions, discordance essentially concerned stent diameter (36.1%), whereas stent length was the main reason for discordance for femoral lesions (36.7%). The median length of follow-up was 18 months (range 6-24). For iliac lesions, freedom from restenosis at 24 months was higher for patients with concordant planning (90% vs. 62.5%, p = 0.045). Most restenoses occurred in the external iliac artery, where there was a tendency towards oversizing of the implanted stent. For femoral lesions, the restenosis-free rate at 24 months was higher for patients with concordant planning (77.8% vs. 50%, p = 0.057). A multivariate analysis was conducted on the prediction of restenosis. Among factors, only discordant planning was found to be a significant predictor of restenosis with an odds ratio of 0.115 (95% confidence interval, 0.02-0.674; p = 0.016). Conclusion The absence of sizing for peripheral lesions engenders a tendency to choose the wrong stent, in particular in terms of diameter in iliac arteries and length in femoral arteries.
目的 本研究评估CT扫描测量支架尺寸对周围动脉疾病再狭窄发生率的影响。方法 这项回顾性研究纳入了2013年4月至2013年10月间因周围动脉疾病接受血管内治疗的59例患者的66处动脉病变。所有患者均有新发髂动脉或股动脉病变，仅为血管内治疗的候选对象，并在术前接受了CTA检查。将实际植入的支架（其尺寸根据术者在术中二维血管造影的经验选择）与根据术前CTA精确测量病变后回顾性选择的“理想”支架进行比较。如果理想支架与实际支架之间的长度差异超过20 mm和/或直径差异超过1 mm，则认为规划“不一致”。结果 对于髂动脉病变，不一致主要涉及支架直径（36.1%），而支架长度是股动脉病变不一致的主要原因（36.7%）。随访时间中位数为18个月（范围6 - 24个月）。对于髂动脉病变，规划一致的患者24个月时无再狭窄率更高（90%对62.5%，p = 0.045）。大多数再狭窄发生在髂外动脉，植入的支架有尺寸过大的趋势。对于股动脉病变，规划一致的患者24个月时无再狭窄率更高（77.8%对50%，p = 0.057）。对再狭窄的预测进行了多因素分析。在各因素中，仅发现规划不一致是再狭窄的显著预测因素，优势比为0.115（95%置信区间，0.02 - 0.674；p = 0.016）。结论 周围病变未进行尺寸测量会导致选择错误支架的倾向，特别是在髂动脉直径和股动脉长度方面。
