Li Y J, Pan X, Wang C, Ma L, He B
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 May 24;48(5):373-377. doi: 10.3760/cma.j.cn112148-20190328-00148.
To investigate the influencing factors of in-stent restenosis (ISR) following successful stent implantation in patients with ablation-associated severe pulmonary vein stenosis (PVS) who undergo atrial fibrillation ablation. Data of patients who underwent pulmonary vein angiography to confirm PVS after radiofrequency ablation for atrial fibrillation (AF) and received pulmonary vein stenting at Shanghai Chest Hospital from March 2010 to December 2017 were retrospectively analysed. All patients were followed up for a long period of time (pulmonary vein contract-enhanced CT within 6 to 12 months after operation was performed, and pulmonary angiography was performed if CT indicated stenosis>50%). The incidence of ISR was recorded. According to angiography, the patients were divided into ISR group and non-ISR group. The clinical and intraoperative imaging characteristics and interventional data were compared between the two groups. Logistic regression was used to analyse the influencing factors of ISR. A total of 47 patients ((47.1±12.2) years old) were enrolled in this study, including 28 males(59.6%). There were 19 cases in ISR group and 28 cases in non-ISR group. Compared with the non-ISR group, the ISR group received more pulmonary vein isolation ((2.8±0.9) vs. (1.8±1.3), 0.02), and the interval between last ablation and stenting was longer ((19.4±9.6) vs. (13.0±12.4), 0.03). The incidence of ISR in patients with stent diameter≤8 mm was significantly higher than those with stent diameter8 mm (33.3%(20/60) vs. 8.1%(3/37), 0.01). Logistic regression analysis found that the number of radiofrequency ablation1 (2.1, 95 1.3-3.9, 0.02), and the time from the last ablation to stent placement12 months (1.5, 95 1.1-2.5, 0.03), reference diameter of stenosed distal vessel (0.7, 95 0.5-0.9, 0.04), post procedural minimal luminal diameter (0.4, 95 0.2-0.8, 0.02) and stent diameter (0.6, 95 0.3-0.9, 0.03) were independent factors of ISR. The greater number of radiofrequency ablations and the longer time from the last ablation to stent placement increase the risk of ISR. The larger reference diameter of the stenosed distal vessel, stent diameter and post procedural minimal luminal diameter are the protective factors of ISR.
为研究房颤消融术后发生消融相关严重肺静脉狭窄（PVS）并成功植入支架患者的支架内再狭窄（ISR）影响因素。回顾性分析2010年3月至2017年12月在上海胸科医院因房颤行射频消融术后经肺静脉造影确诊为PVS并接受肺静脉支架置入术患者的资料。对所有患者进行长期随访（术后6至12个月行肺静脉增强CT检查，若CT提示狭窄>50%则行肺血管造影）。记录ISR发生率。根据血管造影结果将患者分为ISR组和非ISR组。比较两组的临床及术中影像特征和介入数据。采用Logistic回归分析ISR的影响因素。本研究共纳入47例患者（年龄(47.1±12.2)岁），其中男性28例（59.6%）。ISR组19例，非ISR组28例。与非ISR组相比，ISR组接受的肺静脉隔离术更多（(2.8±0.9) 比 (1.8±1.3)，P = 0.02），且最后一次消融与支架置入的间隔时间更长（(19.4±9.6) 比 (13.0±12.4)，P = 0.03）。支架直径≤8 mm患者的ISR发生率显著高于支架直径>8 mm患者（33.3%（20/60）比8.1%（3/37），P = 0.01）。Logistic回归分析发现，射频消融次数≥1次（比值比2.1，95%置信区间1.3 - 3.9，P = 0.02）、最后一次消融至支架置入时间≥12个月（比值比1.5，95%置信区间1.1 - 2.5，P = 0.03）、狭窄远端血管参考直径（比值比0.7，95%置信区间0.5 - 0.9，P = 0.04）、术后最小管腔直径（比值比0.4，95%置信区间0.2 - 0.8，P = 0.02）及支架直径（比值比0.6，95%置信区间0.3 - 0.9，P = 0.03）是ISR的独立影响因素。射频消融次数越多、最后一次消融至支架置入时间越长，ISR风险越高。狭窄远端血管参考直径、支架直径及术后最小管腔直径越大是ISR的保护因素。
