Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China.
Vascular. 2022 Feb;30(1):52-62. doi: 10.1177/1708538121992590. Epub 2021 Feb 10.
Restenosis after stenting for superficial femoral artery atherosclerotic disease remains a significant clinical problem, especially for long-segment lesions. We assessed predictors of in-stent restenosis in patients with long-segment superficial femoral artery disease and hypothesized that pre-procedural ultrasound assessment would predict in-stent restenosis.
This single-center study retrospectively analyzed 283 limbs in 243 patients who treated with superficial femoral artery nitinol stent placement for long-segment (≥15 cm) lesions between 2015 and 2018. Color duplex ultrasound was performed pre-procedure and post-procedure at 3, 6, 12, 24, and 36 months. The endpoint was ≥50% in-stent restenosis in the superficial femoral artery. Primary patency rates were analyzed with Kaplan-Meier survival analysis and compared using the log-rank test. A multivariable Cox proportional hazards model was used to evaluate the risk factors for in-stent restenosis.
The median length of lesions was 25.8 ± 8.1 cm. The cumulative freedom from ≥50% in-stent restenosis at 3, 6, 12, 24, and 36 months was 95.3%, 78.3%, 56.0%, 30.6%, and 15.9%, respectively. Univariate and multivariate Cox regression analysis showed that cumulative lesion length ≥ 25 cm (hazard ratio 1.681; =0.003), calcified plaque (hazard ratio 1.549, =0.006), poor runoff scores >10 (hazard ratio 1.870, =0.003), and chronic renal failure (hazard ratio 2.075, =0.009) were independent risk factors for in-stent restenosis. The agreement rate between ultrasound and angiography was 92.6% for cumulative lesion length ( 0.851) and 91.9% for runoff score ( 0.872).
The results indicate that pre-procedural color duplex ultrasound evaluation is helpful for the selection of appropriate candidates for superficial femoral artery stent placement. Cumulative lesion length ≥25 cm, plaque calcification, poor distal runoff, and chronic renal failure independently predicted in-stent restenosis.
股浅动脉粥样硬化性疾病支架置入后再狭窄仍然是一个重大的临床问题，尤其是对于长段病变。我们评估了长段股浅动脉病变患者支架内再狭窄的预测因素，并假设术前超声评估将预测支架内再狭窄。
这项单中心研究回顾性分析了 2015 年至 2018 年间 243 例患者的 283 条肢体，这些患者接受了股浅动脉 Nitinol 支架置入治疗长段（≥15cm）病变。术前和术后 3、6、12、24 和 36 个月进行彩色双功能超声检查。股浅动脉支架内再狭窄的终点是≥50%。采用 Kaplan-Meier 生存分析比较主通畅率，并采用对数秩检验进行比较。采用多变量 Cox 比例风险模型评估支架内再狭窄的危险因素。
病变的中位长度为 25.8±8.1cm。3、6、12、24 和 36 个月时无≥50%支架内再狭窄的累积无事件生存率分别为 95.3%、78.3%、56.0%、30.6%和 15.9%。单变量和多变量 Cox 回归分析表明，累积病变长度≥25cm（风险比 1.681；=0.003）、钙化斑块（风险比 1.549，=0.006）、侧支循环评分>10（风险比 1.870，=0.003）和慢性肾衰竭（风险比 2.075，=0.009）是支架内再狭窄的独立危险因素。超声与血管造影对累积病变长度的一致性率为 92.6%（ 0.851），对侧支循环评分的一致性率为 91.9%（ 0.872）。
结果表明，术前彩色双功能超声评估有助于选择合适的股浅动脉支架置入候选者。累积病变长度≥25cm、斑块钙化、远端侧支循环不良和慢性肾衰竭独立预测支架内再狭窄。
