高安动脉炎患者经皮介入治疗的结果

Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis.

作者信息

Joseph George, Thomson Viji S, Attumalil Thomas V, Mathen Pratheesh G, Anandaraj Arpudh M, George Oommen K, George Paul V, Goel Ruchika, Kumar Sathish, Mathew John, Danda Debashish

机构信息

Department of Cardiology, Christian Medical College, Vellore, India.

出版信息

J Am Coll Cardiol. 2023 Jan 3;81(1):49-64. doi: 10.1016/j.jacc.2022.10.024.

DOI:10.1016/j.jacc.2022.10.024

PMID:36599610

Abstract

BACKGROUND

The status of vascular lesion treatment using percutaneous intervention (PI) in Takayasu arteritis (TAK) remains unresolved.

OBJECTIVES

This study sought to develop PI strategies appropriate for TAK.

METHODS

A prospectively maintained single-center database of TAK PI procedures from 1996 to 2022 was analyzed retrospectively. Obstructive lesions were treated by elective stenting (using bare or covered stents), balloon angioplasty (BA), or cutting-balloon angioplasty (CBA), with adjunctive stenting for suboptimal BA or CBA results. PIs were repeated in restenotic lesions until sustained success was obtained. Aortic or peripheral aneurysms and spontaneous aortic dissections were treated with covered stents or endografts. Immunosuppressive therapy, started before PI, was continued long term.

RESULTS

A total of 942 patients underwent PI to treat 2,450 arterial lesions (2,365 stenoses or occlusions, 85 aneurysms or dissections) in 630 subclavian or axillary, 586 renal, 463 aortic, 333 carotid, 188 mesenteric, 116 iliac, 71 coronary, and 63 other arteries; 3,805 PIs were performed (1.55 PIs per lesion; range 1-7 PIs per lesion). Early success was obtained in 2,262 (92.3%), and late success in 1,460 (84.5%) of 1,727 lesions with a median of 39 months (IQR: 15-85 months) of follow-up. Repeated PIs increased late success in obstructive lesions from 48.6% to 83.3%. A total of 1,687 elective stenting lesions achieved 88% late success with 1.49 PIs per lesion; covered stents (1.18 PIs per lesion) restenosed less than bare stents (1.51 PIs per lesion; P < 0.001). A total of 183 (36%) of 513 BA-treated lesions had good outcomes without adjunctive stenting; 122 CBA-treated lesions had 19% dissections and 8% ruptures or pseudoaneurysm formations. Aneurysms or dissections had 91.3% late success after PI. A total of 472 complications occurred in 415 (17%) lesions; 375 (79%) were resolved.

CONCLUSIONS

Most vascular lesions in TAK can be effectively, safely, and durably treated using predominantly stent-based PI strategies.

摘要

背景

在大动脉炎（TAK）中，经皮介入治疗（PI）血管病变的现状仍未解决。

目的

本研究旨在制定适合TAK的PI策略。

方法

回顾性分析1996年至2022年前瞻性维护的TAK-PI手术单中心数据库。阻塞性病变采用选择性支架置入术（使用裸支架或覆膜支架）、球囊血管成形术（BA）或切割球囊血管成形术（CBA）治疗，对于BA或CBA效果欠佳的情况采用辅助支架置入术。对再狭窄病变重复进行PI，直至取得持续成功。主动脉或周围动脉瘤以及自发性主动脉夹层采用覆膜支架或腔内移植物治疗。PI术前开始的免疫抑制治疗长期持续。

结果

共有942例患者接受PI治疗，涉及630条锁骨下或腋动脉、586条肾动脉、463条主动脉、333条颈动脉、188条肠系膜动脉、116条髂动脉、71条冠状动脉和63条其他动脉中的2450处动脉病变（2365处狭窄或闭塞、85处动脉瘤或夹层）；共进行了3805次PI（每处病变1.55次PI；范围为每处病变1 - 7次PI）。1727处病变中，2262处（92.3%）取得早期成功，1460处（84.5%）取得晚期成功，中位随访时间为39个月（IQR：15 - 85个月）。重复PI使阻塞性病变的晚期成功率从48.6%提高到83.3%。1687处选择性支架置入病变的晚期成功率为88%，每处病变平均进行1.49次PI；覆膜支架（每处病变1.18次PI）再狭窄率低于裸支架（每处病变1.51次PI；P < 0.001）。513处接受BA治疗的病变中，183处（36%）在无辅助支架置入的情况下取得良好结果；122处接受CBA治疗的病变有19%发生夹层，8%发生破裂或假性动脉瘤形成。PI术后，动脉瘤或夹层的晚期成功率为91.3%。415处（17%）病变共发生472例并发症；375例（79%）得到解决。