Doctor of Medicine, Dijon University Hospital, Dijon, France.
Doctor of Medicine, Dijon University Hospital, Dijon, France.
Ann Vasc Surg. 2024 Sep;106:37-50. doi: 10.1016/j.avsg.2024.02.017. Epub 2024 Apr 9.
The primary treatment for lower-extremity peripheral arterial occlusive disease (PAOD) is angioplasty stenting. Its main complication is in-stent restenosis. Poor selection of stent dimensions has been identified as a factor contributing to early in-stent restenosis. The aim of this study is to determine whether the implantation of stents, selected based on arterial morphological reconstruction using a sizing software program, reduces the occurrence of in-stent restenosis. The study also aims to evaluate the potential benefits of routine preoperative sizing.
Between January 2016 and December 2020, all patients treated for PAOD through scheduled angioplasty stenting in our department were included in the study. Using systematic preoperative computed tomography angiography, precise reconstruction and sizing were performed to select the ideal length and diameter of stents, resulting in the selection of a so-called IDEAL stent. During the procedure, the surgeon implanted either the IDEAL stent or a different one, named the ACTUAL stent, based on intraoperative data and/or availability. We compared the in-stent restenosis rate between IDEAL and ACTUAL stents.
There were no significant differences in the overall characteristics between the IDEAL and ACTUAL stent groups. The in-stent restenosis rate at 1 year was 13% (N = 28/212, P = 0.994) in the IDEAL group and 17% (N = 25/149, P = 0.994) in the ACTUAL group. Among the ACTUAL stents, a total of 19.6% of stents with a diameter mismatch when chosen based on arteriography showed a significantly higher restenosis rate during the first year of follow-up (P = 0.02).
Our study did not demonstrate a significant difference in 1-year restenosis rate between the IDEAL and the ACTUAL stent groups. It specifically revealed the significant impact of diameter selection on the intrastent restenosis rate during the first year of follow-up. Stents chosen based on arteriographic criteria, which exhibited diameter discordance, compared to the IDEAL stents group selected using sizing reconstructions, could be either oversized or undersized. This led to a significantly higher restenosis rate at 1 year postoperatively.
下肢外周动脉阻塞性疾病（PAOD）的主要治疗方法是血管成形术支架置入。其主要并发症是支架内再狭窄。支架尺寸选择不当已被确定为导致早期支架内再狭窄的一个因素。本研究旨在确定基于血管形态重建的支架尺寸选择是否可以降低支架内再狭窄的发生。该研究还旨在评估常规术前尺寸选择的潜在益处。
本研究纳入 2016 年 1 月至 2020 年 12 月期间在我科行计划性血管成形术支架置入治疗的所有 PAOD 患者。使用系统的术前计算机断层血管造影术，进行精确的重建和尺寸选择，以选择理想的支架长度和直径，从而选择所谓的 IDEAL 支架。在手术过程中，根据术中数据和/或可用性，外科医生植入 IDEAL 支架或另一种支架，称为 ACTUAL 支架。我们比较了 IDEAL 支架和 ACTUAL 支架之间的支架内再狭窄率。
在 IDEAL 支架和 ACTUAL 支架组之间，总体特征无显著差异。在 IDEAL 支架组，1 年时的支架内再狭窄率为 13%（N=28/212，P=0.994），在 ACTUAL 支架组为 17%（N=25/149，P=0.994）。在 ACTUAL 支架中，根据血管造影选择时存在直径不匹配的支架总数，在随访的第一年有更高的再狭窄率（P=0.02）。
本研究未显示 IDEAL 支架组和 ACTUAL 支架组在 1 年再狭窄率方面有显著差异。它特别揭示了直径选择对随访第一年支架内再狭窄率的显著影响。与基于尺寸重建选择的 IDEAL 支架组相比，根据血管造影标准选择的支架，其直径存在差异，可能过大或过小，导致术后 1 年再狭窄率显著升高。
