准分子激光斑块消蚀术联合药物球囊干预股腘动脉支架再狭窄的疗效分析

Efficacy of excimer laser atherectomy combined with drug-coated balloon angioplasty in treatment of patients with femoral-popliteal artery in-stent restenosis

关键词:  支架内再狭窄  准分子激光  药物涂层球囊  普通球囊

Key words:  in-stent restenosis  excimer laser  drug-coated balloon  plain old balloon

摘要:

目的对比准分子激光消蚀术(excimer laser ablation, ELA)联合药物涂层球囊(drug-coated balloon, DCB)与联合普通球囊(plain old balloon angioplasty, POBA)治疗股腘动脉支架内再狭窄(femoral-popliteal artery in-stent restenosis, FP-ISR)的疗效。 方法回顾性收集27例FP-ISR患者的临床资料，其中ELA+DCB组15例，ELA+POBA组12例，观察两组免于补救支架成功率和并发症发生率，以及手术前后踝肱指数(ankle brachial index, ABI)变化，并比较两组一期通畅率。 结果所有患者均成功开通支架狭窄段，其中ELA+DCB组和ELA+POBA组补救性支架各3例，两组免于补救支架成功率分别为80.0%和75.0%（P=1.000），各出现远端栓塞1例，无血管穿孔、血肿、假性动脉瘤、死亡等并发症发生（P=1.000）。两组术后ABI较术前显著提高(P<0.001)，生存分析显示两组术后3、6和12个月的一期通畅率分别为93.3%和83.3%，86.3%和66.7%，75.4%和44.4%（Log-rank检验，χ2=4.351，P=0.037）。多因素Cox回归分析表明DCB是术后通畅性的独立保护因素（HR=0.135，95%CI: 0.0230.782，P=0.025)。 结论ELA联合DCB或POBA治疗FP-ISR均具有良好的免于补救支架成功率和安全性，但ELA联合DCB具有更高的早中期通畅率。

Abstract:

ObjectiveTo investigate the efficacy of excimer laser ablation(ELA) combined with drug-coated balloon(DCB) or plain old balloon(POBA) in the treatment of femoral-popliteal artery in-stent restenosis（FP-ISR）. MethodsClinical data of 27 patients with FP-ISR were retrospectively analyzed, including 15 cases treated with ELA+DCB and 12 cases treated with ELA+POBA. The salvage stenting-free success rate, the incidence of complications and the changes of ankle brachial index(ABI) before and after surgery were observed in both groups. The primary patency rates were compared between the two groups. ResultsThe stenotic segments of the stent were successfully opened in all patients. Three cases in each group received salvage stenting, and the salvage stenting-free success rates in ELA+DCB and ELA+POBA groups were 80.0%(12/15) and 75.0%(9/12), respectively. One case of distal embolism occurred in each group, and no vascular perforation, hematoma, pseudoaneurysm or death were observed in both groups. The postoperative ABI was significantly improved compared to that before the operation in two groups(P<0.001). The primary patency rates at 3, 6, and 12 months after surgery were 93.3% and 83.3%, 86.3% and 66.7%, 75.4% and 44.4% in the ELA+DCB and ELA+POBA groups, respectively（Log-rank test, χ2=4.351, P=0.037）. Multivariate Cox regression analysis showed that DCB is an independent protective factor for postoperative patency(HR=0.135, 95%CI: 0.023-0.782, P=0.025). ConclusionELA combined with DCB or POBA are effective and safe for treatment of patients with femoropopliteal in-stent restenosis, while ELA combined with DCB may have higher patency rates in early and middle stages.