Department of Vascular Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Accident and Emergency Medicine, North District Hospital, Hong Kong SAR, China.
Eur J Vasc Endovasc Surg. 2019 Aug;58(2):215-222. doi: 10.1016/j.ejvs.2019.01.025. Epub 2019 Mar 9.
Plaque calcification and stent oversizing are two key factors contributing to in stent restenosis (ISR) following femoropopliteal stent angioplasty. This study aimed to explore a pre-operative quantitative assessment method of plaque calcification and rational parameters of stent oversizing in the femoropopliteal artery.
A total of 115 patients with atherosclerotic femoropopliteal arterial occlusive disease treated from January 2013 to January 2016 were included retrospectively. Computed tomography angiography (CTA) imaging was performed to analyse calcified plaque parameters (calcified plaque volume [CV], standard CV [SCV], burden of calcified plaque) and stent oversizing parameters at different vessel segments (distal oversizing, maximum oversizing, plaque oversizing). Optimal cut offs for the six parameters were determined by the maximum Youden's index. The relationship between calcified plaque, stent oversizing, and clinical outcomes were assessed by correlation analysis and multivariable Cox regression models.
The one year primary patency rate was 77.4%; the rates of ISR, major amputation, target lesion revascularisation, and mortality were 40.9%, 8.7%, 17.4%, and 12.2%, respectively. For all six parameters, patients with values greater than the cut offs had a significantly higher incidence of ISR than those with values below the cut offs. ISR was positively correlated with all six calcification and oversizing parameters. Amputation and mortality were positively correlated with calcification parameters. Multivariable Cox regression analysis demonstrated that all six parameters were independent risk factors for ISR. All calcification parameters were identified as independent risk factors for amputation, while only CV and SCV were independent risk factors for mortality.
Calcified plaque in the femoropopliteal artery can be quantitatively analysed on pre-operative CTA images. High calcified plaque burden and excessive stent oversizing were associated with unfavourable outcomes following stent angioplasty.
斑块钙化和支架过度扩张是导致股腘动脉支架血管成形术后再狭窄（ISR）的两个关键因素。本研究旨在探讨一种股腘动脉支架成形术前定量评估斑块钙化和合理支架扩张参数的方法。
回顾性分析 2013 年 1 月至 2016 年 1 月收治的 115 例股腘动脉粥样硬化性闭塞性疾病患者。采用计算机断层血管造影（CTA）成像分析钙化斑块参数（钙化斑块体积[CV]、标准 CV[SCV]、钙化斑块负荷）和不同血管节段的支架扩张参数（远端扩张、最大扩张、斑块扩张）。通过最大 Youden 指数确定 6 个参数的最佳截断值。采用相关性分析和多变量 Cox 回归模型评估钙化斑块、支架扩张与临床结局的关系。
1 年原发性通畅率为 77.4%；ISR、大截肢、靶病变血运重建和死亡率分别为 40.9%、8.7%、17.4%和 12.2%。对于所有 6 个参数，截点值以上患者的 ISR 发生率明显高于截点值以下患者。ISR 与所有 6 个钙化和扩张参数均呈正相关。截肢和死亡率与钙化参数呈正相关。多变量 Cox 回归分析显示，所有 6 个参数均为 ISR 的独立危险因素。所有钙化参数均为截肢的独立危险因素，而 CV 和 SCV 为死亡率的独立危险因素。
术前 CTA 图像可对股腘动脉钙化斑块进行定量分析。高钙化斑块负荷和支架过度扩张与支架血管成形术后不良结局相关。
Zotero 插件