1 Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
2 Medical Faculty, Semmelweis University, Budapest, Hungary.
J Endovasc Ther. 2018 Oct;25(5):632-639. doi: 10.1177/1526602818794959. Epub 2018 Aug 20.
To determine the long-term patency of aortoiliac kissing stents and to identify predisposing factors for the development of in-stent restenosis (ISR).
A retrospective analysis was conducted of 105 patients (median age 60.9 years; 64 women) with symptomatic aortoiliac occlusive disease who had kissing stents implanted between 2001 and 2015. The indication for kissing stents was severe claudication in 91 (86.7%) patients and critical limb ischemia in 14 (13.3%). Lesions were TASC A in 52 (49.5%), B in 29 (27.6%), C in 4 (3.8%), and D in 20 (19%) patients. Twenty-five (23.8%) patients had heavily calcified lesions. In all, 210 stents were deployed [180 (85.7%) self-expanding and 30 (14.3%) balloon-expandable]. Follow-up included clinical evaluation, ankle-brachial index measurement, and duplex ultrasonography.
The median follow-up was 45 months. The primary patency rates were 93%, 86%, and 77% at 12, 24, and 60 months, respectively. Significant ISR developed in 23 (21.9%) patients (12 unilateral and 11 bilateral). Univariate Cox regression analysis revealed older age [hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.31 to 0.81, p=0.004] and larger aortic diameter (HR 0.42, 95% CI 0.25 to 0.7, p<0.001) to be variables favoring long-term patency, while a longer aortic stent segment (HR 1.56, 95% CI 1.16 to 2.09, p=0.003) and a larger discrepancy between the summed stent diameters and the aortic diameter (HR 1.64, 95% CI 1.01 to 2.65, p=0.043) were associated with ISR development. Multivariate analysis showed a longer aortic stent segment to be the only significant determinant of ISR (HR 1.44, 95% CI 1.02 to 2.01, p=0.035).
The kissing stent technique can be performed with good long-term patency. Patients whose iliac stents protrude too far into the aorta need closer follow-up.
确定主动脉-髂动脉吻部支架的长期通畅率，并确定支架内再狭窄（ISR）发生的相关因素。
回顾性分析了 105 例（中位年龄 60.9 岁；64 例女性）患有症状性主髂动脉闭塞性疾病的患者，这些患者在 2001 年至 2015 年间接受了吻部支架植入治疗。91 例（86.7%）患者的适应证为严重跛行，14 例（13.3%）为严重肢体缺血。病变 TASC A 52 例（49.5%），B 29 例（27.6%），C 4 例（3.8%），D 20 例（19%）。25 例（23.8%）患者有严重钙化病变。共植入 210 个支架[180 个（85.7%）为自膨式，30 个（14.3%）为球囊扩张式]。随访包括临床评估、踝肱指数测量和双功能超声检查。
中位随访时间为 45 个月。12、24 和 60 个月时的主要通畅率分别为 93%、86%和 77%。23 例（12 例单侧，11 例双侧）患者出现明显的 ISR。单因素 Cox 回归分析显示，年龄较大（风险比[HR]0.5，95%置信区间[CI]0.31 至 0.81，p=0.004）和主动脉直径较大（HR 0.42，95%CI 0.25 至 0.7，p<0.001）是影响长期通畅率的变量，而主动脉支架节段较长（HR 1.56，95%CI 1.16 至 2.09，p=0.003）和支架总直径与主动脉直径差值较大（HR 1.64，95%CI 1.01 至 2.65，p=0.043）与 ISR 发生相关。多因素分析显示，主动脉支架节段较长是 ISR 的唯一显著决定因素（HR 1.44，95%CI 1.02 至 2.01，p=0.035）。
吻部支架技术具有良好的长期通畅率。髂部支架突入主动脉过长的患者需要更密切的随访。
