Ettles D F, MacDonald A W, Burgess P A, Nicholson A A, Dyet J F
Department of Radiology, Hull Royal Infirmary, East Yorkshire, United Kingdom.
Cardiovasc Intervent Radiol. 1998 Nov-Dec;21(6):475-80. doi: 10.1007/s002709900307.
To assess the feasibility and efficacy of directional atherectomy in the treatment of iliac stent stenosis or occlusion and to evaluate the histologic composition of excised atherectomy specimens.
Directional atherectomy of six occluded and 10 severely stenosed iliac stents was undertaken in 12 patients at a mean interval of 28 months (range 3-69 months) after stent insertion for occlusive aortoiliac disease. In cases of stent occlusion, atherectomy was preceded by low-dose thrombolysis. In all patients stent clearance with return of femoral pulses was achieved within 24 hr and there were no significant complications. All excised specimens were sent for histologic examination.
Eleven patients (92%) remain symptom free with unlimited walking distance at a mean follow-up interval of 11.5 months (range 3-31 months) after treatment. Histologic examination revealed typical myointimal hyperplasia at three excision sites, intimal fibrosis at three sites, atheroma at four sites and organized thrombus at six sites.
Atherectomy offers an effective treatment in iliac stent occlusion and restenosis with no significant adverse effects. Debulking of these lesions seems to offer a more logical approach than simple balloon angioplasty. Clinical and duplex follow-up confirms satisfactory outcome within the first year but longer-term results are not yet known. The histologic data obtained demonstrate that stent restenosis and occlusion are likely to be multifactorial, and challenge the assumption that myointimal hyperplasia is the sole cause of iliac stent occlusion.
评估定向旋切术治疗髂动脉支架狭窄或闭塞的可行性和疗效，并评估旋切术切除标本的组织学构成。
对12例因主髂动脉闭塞性疾病而植入支架的患者进行了定向旋切术，其中6例为髂动脉支架闭塞，10例为严重狭窄，平均在支架植入后28个月（范围3 - 69个月）进行。对于支架闭塞的病例，在旋切术前先进行小剂量溶栓治疗。所有患者在24小时内实现了支架开通并恢复股动脉搏动，且无明显并发症。所有切除标本均送去做组织学检查。
11例患者（92%）在治疗后平均随访11.5个月（范围3 - 31个月）时无症状，行走距离不受限。组织学检查显示，三个切除部位有典型的肌内膜增生，三个部位有内膜纤维化，四个部位有动脉粥样硬化，六个部位有机化血栓。
旋切术是治疗髂动脉支架闭塞和再狭窄的有效方法，且无明显不良反应。对这些病变进行减容似乎比单纯球囊血管成形术提供了一种更合理的方法。临床和双功超声随访证实第一年结果令人满意，但长期结果尚不清楚。所获得的组织学数据表明，支架再狭窄和闭塞可能是多因素的，并对肌内膜增生是髂动脉支架闭塞唯一原因这一假设提出了挑战。
