Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Neurointerv Surg. 2019 Jun;11(6):574-578. doi: 10.1136/neurintsurg-2018-014243. Epub 2018 Oct 18.
The study was designed to investigate if vascular occlusion in the internal carotid artery (ICA) or the contralateral vertebral artery (VA) contribute to developing in-stent restenosis (ISR) in patients with vertebral artery ostium stenosis (VAOS).
420 consecutive patients treated with VAOS stents (from a population of 8145 patients with VAOS) from January 2013 to December 2014 were analyzed in this retrospective study; 216 with drug eluted stents and 204 with bare metal stents. Based on pre-stent DSA findings, patients were divided into four groups: both carotid and vertebral arteries patent (PAT), ICA occlusion (ICA-OCC), contralateral VA occlusion (CVA-OCC), and combined occlusions (C-OCC). The incidence of ISR (stenosis >50%) was compared between groups using Cox regression analysis.
Of the 420 patients, the mean incidence of ISR was 36.4%, with a median 12 months of follow-up (IQR 3-12). Logistic regression analysis showed that drug eluting stent had less ISR than bare metal stent (OR=0.38, 95% CI 0.19 to 0.75, P=0.01). Cox regression analysis showed that CVA-OCC (HR=1.63, P=0.02) and C-OCC (HR=3.30, P=0.001) were risk factors for ISR but not ICA-OCC (P=0.31). In the CVA-OCC and C-OCC groups, in-stent peak systolic velocity (PSV) ≥140 cm/s, 1 day after successful stenting, was associated with subsequent development of ISR (OR=2.81, 95% CI 1.06 to 7.43, P=0.04).
Contralateral VA occlusion at the time of stenting increased the risk of ISR, especially if stent PSV on day 1 was >140 cm/s. Bare metal stents had more ISR than drug eluting stents.
本研究旨在探讨颈内动脉（ICA）或对侧椎动脉（VA）血管闭塞是否导致椎动脉开口狭窄（VAOS）患者支架内再狭窄（ISR）。
回顾性分析 2013 年 1 月至 2014 年 12 月期间 8145 例 VAOS 患者中接受 VAOS 支架治疗的 420 例患者的资料，其中药物洗脱支架 216 例，裸金属支架 204 例。根据支架前 DSA 检查结果，患者分为四组：双侧颈内动脉和椎动脉通畅（PAT）、颈内动脉闭塞（ICA-OCC）、对侧椎动脉闭塞（CVA-OCC）和联合闭塞（C-OCC）。采用 Cox 回归分析比较各组 ISR（狭窄率>50%）的发生率。
420 例患者中，ISR 的平均发生率为 36.4%，中位随访时间为 12 个月（IQR 3-12）。Logistic 回归分析显示，药物洗脱支架的 ISR 发生率低于裸金属支架（OR=0.38，95%CI 0.19 至 0.75，P=0.01）。Cox 回归分析显示，CVA-OCC（HR=1.63，P=0.02）和 C-OCC（HR=3.30，P=0.001）是 ISR 的危险因素，但 ICA-OCC 不是（P=0.31）。在 CVA-OCC 和 C-OCC 组中，支架内收缩期峰值流速（PSV）≥140 cm/s，支架置入后 1 天，与后续 ISR 的发生相关（OR=2.81，95%CI 1.06 至 7.43，P=0.04）。
支架置入时对侧 VA 闭塞增加了 ISR 的风险，尤其是支架内 PSV>140 cm/s 时。裸金属支架的 ISR 发生率高于药物洗脱支架。
