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支架诱导的炎症:静脉和动脉手术中植入后综合征的比较横断面研究。

Stent-Induced Inflammation: A Comparative Cross-Sectional Study of Post-Implantation Syndrome in Venous and Arterial Procedures.

作者信息

Dikmen Nur, Ozcinar Evren, Hasde Ali Ihsan, Kayan Ahmet, Polat Nadir, Ardakani Ali, Kadiroğlu Yuruyen Ezel, Eyileten Zeynep

机构信息

Cardiovascular Surgery Department, Faculty of Medicine, Ankara University, 06100 Ankara, Turkey.

Cardiovascular Surgery Department, Kirikkale High Specialization Hospital, 71300 Kirikkale, Turkey.

出版信息

J Clin Med. 2024 Oct 5;13(19):5937. doi: 10.3390/jcm13195937.

Abstract

Postimplantation syndrome (PIS) is a known inflammatory response following endovascular stent placement, yet comparative data between venous and arterial stenting remains limited. This study seeks to evaluate the incidence, characteristics, and clinical implications of PIS across these two distinct vascular territories. We retrospectively analyzed 191 patients who underwent either venous (n = 36) or arterial (n = 155) stent placement. Data collection encompassed demographic profiles, perioperative laboratory findings, and clinical outcomes. The primary endpoint was the incidence of PIS, defined as the presence of fever (≥38 °C), leukocytosis, and elevated C-reactive protein (CRP) within 30 days postprocedure. Secondary outcomes included length of hospital and ICU stay, incidence of endoleaks, reintervention rates, and 30-day mortality. Comparative statistical analyses were conducted to assess differences between the venous and arterial stent groups. PIS was observed more frequently in arterial stent patients, as evidenced by significantly elevated postoperative white blood cell counts at 24 and 48 h ( = 0.046 and = 0.014, respectively), along with borderline CRP increases ( = 0.052). Fever occurrence peaked at 72 and 96 h postprocedure, predominantly in the arterial cohort. Furthermore, patients with arterial stents had significantly longer hospital stays (5.59 ± 0.46 days vs. 3.42 ± 0.36 days; = 0.0018) and a higher rate of 30-day endoleaks (7.1% vs. 0%; = 0.005). Despite similar mortality and major adverse cardiac event (MACE) rates between groups, arterial stent patients exhibited a greater need for reintervention. While PIS was less common among venous stent recipients, its potential impact on postoperative recovery warrants careful monitoring. Arterial stenting is associated with a higher incidence of PIS and a more pronounced systemic inflammatory response, contributing to longer hospitalization and increased postoperative complications. Although venous stent patients experience PIS less frequently, its occurrence should not be overlooked, as it may influence overall recovery and clinical outcomes. Recognition and management of PIS in both venous and arterial stent patients are critical to improving patient care and optimizing procedural success.

摘要

植入后综合征(PIS)是血管内支架置入术后已知的炎症反应,但静脉和动脉支架置入术之间的比较数据仍然有限。本研究旨在评估PIS在这两个不同血管区域的发生率、特征及临床意义。我们回顾性分析了191例行静脉(n = 36)或动脉(n = 155)支架置入术的患者。数据收集包括人口统计学资料、围手术期实验室检查结果及临床结局。主要终点是PIS的发生率,定义为术后30天内出现发热(≥38°C)、白细胞增多及C反应蛋白(CRP)升高。次要结局包括住院时间和重症监护病房(ICU)住院时间、内漏发生率、再次干预率及30天死亡率。进行比较统计分析以评估静脉和动脉支架组之间的差异。PIS在动脉支架患者中更常见,术后24小时和48小时白细胞计数显著升高(分别为P = 0.046和P = 0.014)以及CRP升高接近临界值(P = 0.052)证明了这一点。发热发生率在术后72小时和96小时达到峰值,主要出现在动脉组。此外,动脉支架患者的住院时间显著更长(5.59±0.46天对3.42±0.36天;P = 0.0018),30天内漏发生率更高(7.1%对0%;P = 0.005)。尽管两组之间的死亡率和主要不良心脏事件(MACE)发生率相似,但动脉支架患者对再次干预的需求更大。虽然PIS在静脉支架接受者中不太常见,但其对术后恢复的潜在影响值得密切监测。动脉支架置入术与更高的PIS发生率和更明显的全身炎症反应相关,导致住院时间延长和术后并发症增加。虽然静脉支架患者发生PIS的频率较低,但其发生不应被忽视,因为它可能影响总体恢复和临床结局。认识和管理静脉和动脉支架患者中的PIS对于改善患者护理和优化手术成功率至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/973e/11477928/9c4a398c227e/jcm-13-05937-g001.jpg

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