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1、解放军总医院血管外科 贾鑫、郭伟、刘小平、尹太、熊江、马晓辉等 ,如何应对支架内再狭窄证据及展望,血管外科医生最头痛的问题 开刀移植物闭塞 腔内支架内再狭窄(ISR),支架内再狭窄ISR:In-Stent Restenosis 病理:几乎全部内膜增生 病因:病变部位、病变长度、支架数量、流入流出道 支架断裂可能原因,造成血管壁回缩和刺激内膜增生 抗血小板药物降低ISR?,PTA plus (or) Stent Atherectomy Laser Stentgraft DES or DEB Cryoplasty,PTA+STENT 再狭窄率 颈动脉5 肾动脉1020 髂动脉520 腹股沟以下动脉
2、2550,Zellar etc, Cath Cardiovasc Interv, 2007, 70,SFA易再狭窄 路径长,侧支少 内收肌管挤压 闭塞多于狭窄,SFA裸支架通畅率(Freedom from TLR) Dorrucci J Vasc Surg, Aug 2004,PTA plus (or) Stent Atherectomy Laser Stentgraft DES or DEB Cryoplasty,Atherectomy data SFA病变,22%闭塞, 18狭窄,平均长度46mm 24月随访,84例 ABI术前0.62,术后0.84,随访0.72 1年通畅率91%, 2年
3、通畅率80 Zellar etc, J Endo Ther, 2007 Apri,LACI(Laser Assisted Angioplasty for Critical Limb Ischemia) 127人,随访6月 SFA病变,平均长度38mm Free from TLR 85% J Laird, etc J Vasc Surg, 2007, Aug,Cryoplasty - Big CHILL trial Prospective multicenter registry 诱导VSMC凋亡, 弹力纤维变性,从而减少弹性回缩 录入102患者,SFA长度48mm, 狭窄病变 9月随访,通畅率
4、72 Laird J etc, J vasc interv radiol 2005, Feb,Covered stent for SFA J Vasc Surg, 2007, May,DES for SFA M Dake, Charing cross 2009, May, presentation,BTK drug eluting stent trial J Endo Ther, 2005, Dec J Cardio Surg, 2007, Apri,Drug coated balloon(Thunder trial) 6 month follow-up Mean 65mm, SFA T Da
5、s, 2009 VIVA presentation,PTA plus (or) Stent:直径、长度 Atherectomy Laser Stentgraft Cryoplasty DES or DEB,腔内治疗ISR PTASTENT Cutting balloon Brachytherapy Laser Stentgraft DES or DEB,Cutting balloon 31 patients 36 lesions, CLI Length 32.4mm Primary patency 61% 6 month Limb salvage 83% Bosiers M etc, vasc
6、ular, 2009, Feb,Laser/PTA+支架血管 39人,SFA, ISR Rutherford Class 1-6, mean 3 病变平均长度 27cm,(5-44cm) Gary ansel J Vasc Surg, 2009, May,6月随访 Primary patency 73% Primary assisted patency 76% Occluded 24% 18月随访 Primary patency 52% Primary assisted patency 67%,Brachytherapy 13例肾动脉支架术后ISR PTA+brachytherapy(12Gy Gamma) 结果:80通畅率12月 Stoeteknuel etc J Endo Therapy,2002,Zellar etc, Cath Cardiovasc Interv, 2007, 70,PTASTENT Cutting balloon Brachytherapy Laser Stentgraft DES or DEB,谢 谢,