Katsuki Tomonori, Tomoi Yusuke, Yamaji Kyohei, Soga Yoshimitsu, Imada Kazuaki, Ito Nobuhiro, Hiramori Seiichi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, 802-0001, Japan.
Heart Vessels. 2020 Nov;35(11):1502-1509. doi: 10.1007/s00380-020-01631-y. Epub 2020 May 27.
To examine clinical outcomes for combination therapy of heparin-bonded covered stent [VIABAHN™ stent (VIA)] and bare-nitinol stent (BNS), and to determine independent predictors of restenosis after VIA implantation assessed by intravascular ultrasound (IVUS). A retrospective analysis was conducted on VIA use in the femoropopliteal artery of 71 patients (81 lesions) treated between June 2012 and November 2018. We divided the treated lesions into two groups; that is, whether BNS was added at the proximal site of the VIA or not (combination of VIA and BNS group [COM; n = 21] vs. VIA group [n = 60]). The median follow-up duration was 21.6 months (interquartile range, 13.2-28.8 months). Restenosis at 2 years was observed in 5 lesions (33%) in COM group and 17 lesions (38%) in VIA group (log-rank, P = 0.74). In VIA group, 14 lesions developed restenosis within 12 months. Multivariate logistic regression analysis of VIA group revealed that the proximal plaque burden was an independent predictor of restenosis within 12 months after VIA implantation (odds ratio 1.15, 95% confidence interval 1.01-1.30, P = 0.01), with the optimal cutoff value of 43% (area under the receiver operator characteristic curve 0.79, sensitivity 91%, specificity 69%). A remaining plaque of > 43% at the proximal reference segment was an independent predictor of restenosis after VIA implantation. When residual stenosis is observed at the proximal site of SFA after VIA implantation, combination therapy of VIA and BNS would be an optimal management.
为研究肝素涂层覆膜支架[VIABAHN™支架（VIA）]与裸镍钛诺支架（BNS）联合治疗的临床疗效，并确定血管内超声（IVUS）评估的VIA植入术后再狭窄的独立预测因素。对2012年6月至2018年11月期间治疗的71例患者（81处病变）股腘动脉使用VIA的情况进行回顾性分析。我们将治疗的病变分为两组；即VIA近端部位是否添加BNS（VIA与BNS联合组[COM；n = 21]与VIA组[n = 60]）。中位随访时间为21.6个月（四分位间距，13.2 - 28.8个月）。COM组2年时5处病变（33%）出现再狭窄，VIA组17处病变（38%）出现再狭窄（对数秩检验，P = 0.74）。在VIA组中，14处病变在12个月内出现再狭窄。对VIA组进行多因素逻辑回归分析显示，近端斑块负荷是VIA植入术后12个月内再狭窄的独立预测因素（比值比1.15，95%置信区间1.01 - 1.30，P = 0.01），最佳截断值为43%（受试者工作特征曲线下面积0.79，敏感性91%，特异性69%）。近端参考节段剩余斑块>43%是VIA植入术后再狭窄的独立预测因素。VIA植入术后在股浅动脉近端部位观察到残余狭窄时，VIA与BNS联合治疗将是最佳处理方法。
