PALMAZ支架在颈动脉支架置入术后再狭窄中的应用研究-现代医学

PALMAZ支架在颈动脉支架置入术后再狭窄中的应用研究

单位：南京医科大学附属江宁医院神经内科, 江苏南京 211100

分类号：R543.4

出版年·卷·期（页码）：2017·36·第十二期（1737-1740）

摘要：

目的：探讨PALMAZ球囊扩张支架在颈动脉支架置入术后再狭窄患者中的应用价值。方法：我院2013年4月至2017年1月共进行颈动脉支架置入术340例，通过随访复查，发现16例存在较严重的再狭窄（>50%），其中有8例应用PALMAZ球囊扩张支架治疗再狭窄。结果：8例患者术后即刻复查造影发现，血管狭窄率均小于10%，临床症状明显改善。但是术中均出现血流动力学改变，如心率减慢和血压下降，经过对症处理，症状消失。结论： PALMAZ球囊扩张支架具有安全、有效、可操作性较好等特点，值得我们进一步观察疗效。

Objective: To investigate the value of PALMAZ balloon-expandable stent in in-stent restenosis after carotid artery stenting.Methods: A total of 340 patients underwent placement of carotid stent from April 2013 to January 2017in our hospital. Significant in-stent restenosis (>50%) was found in 16 patients during follow-up visits and 8 of them underwent a PALMAZ balloon-expandable stent implantation.Results: Eight patients underwent digital subtraction angiography after the secondary stent implantation. The vascular restenosis rate of eight patients were all less than 10% after the secondary stent implantation. There were better improvement of clinical symptoms after the secondary stent implantation. However, eight patients had unstable hemodynamics, defined as bradycardia or hypotension during the intraoperative period. The symptoms disappeared after proper treatment.Conclusion: PALMAZ balloon-expandable stent can be a safe, effective and operable choice for the treatment of in-stent restenosis after carotid artery stenting. Further study of the effect of balloon-expandable stent is warranted.

参考文献：

[1] NAKAGAWA I,PARK H S,YOKOYAMA S,et al.Pretreatment with and ongoing use of omega-3 fatty acid ethyl esters reduce the slow-flow phenomenon and prevent in-stent restenosis in patients undergoing carotid artery stenting[J].J Vasc Surg,2017,66(1):122-129.
[2] CALVET D,MAS J L.Recent advances in carotid angioplasty and stenting[J].Int J Stroke,2016,11(1):19-27.
[3] NIJHOFF F,STELLA P R,TROOST M S,et al.Comparative assessment of the antirestenotic efficacy of two paclitaxel drug-eluting balloons with different coatings in the treatment of in-stent restenosis[J].Clin Res Cardiol,2016,105(5):401-411.
[4] LAI C H,SU C S,LEE W L,et al.Modified drug-eluting balloon angioplasty to treat high-risk carotid in-stent restenosis[J].Perfusion,2017,32(5):409-412.
[5] POURIER V E,de BORST G J.Technical options for treatment of in-stent restenosis after carotid artery stenting[J].J Vasc Surg,2016,64(5):1486-1496.
[6] 龚怡,王兴田,厉志洪,等.颈动脉低回声斑块超声造影增强特征与急性缺血性脑血管病的相关性研究[J].现代医学,2016,44(12):1660-1663.
[7] MEHTA S,邓刚.磁共振血管造影与数字减影血管造影在脑血管狭窄闭塞性疾病诊断中的比较研究[J].东南大学学报:医学版,2013,32(6):655-662.
[8] GAUDRY M,BARTOLI J M,BAL L,et al.Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis[J].PLoS One,2016,11(9):e0161716.
[9] GOEL S A,GUO LW,LIU B,et al.Mechanisms of post-intervention arterial remodeling[J].Cardiovasc Res,2012,96(3):363-371.
[10] MATSUMOTO H,YAKO R,MASUO O,et al.A case of in-stent neoatherosclerosis 10 years after carotid artery stent implantation:observation with optical coherence tomography and plaque histological findings[J].Neurol Med Chir (Tokyo),2014,54(2):139-144.
[11] di GIOIA G,CAMPANALE C M,MEGA S,et al.Percutaneous treatment of recurrent in-stent restenosis of carotid artery stenting:a case report and state-of-the-art review[J].Am J Case Rep,2015,16:558-562.
[12] AGOSTINUCCI A,CUMINO A,SUITA R,et al.Carotid bypass using gore hybrid vascular graft for in-stent restenosis after carotid stenting[J].Ann Vasc Surg,2017,39:291.e7-291.e10.
[13] ZHANG C,WANG Z,ZHENG H,et al.Self-expanding stents in the treatment of carotid artery subtotal occlusion:a clinical study on the patients of Hubei and Sichuan in China[J].Biomed Mater Eng,2012,22(1-3):27-33.
[14] TSURUMI A,MIYACHI S,HOSOSHIMA O,et al.Can periprocedural hypotension in carotid artery stenting be predicted? A carotid morphologic autonomic pathologic scoring model using virtual histology to anticipate hypotension[J].Interv Neuroradiol,2009,15(1):17-28.
[15] MYLONAS S N,MOULAKAKIS K G,ANTONOPOULOS C N,et al.Carotid artery stenting-induced hemodynamic instability[J].J Endovasc Ther,2013,20(1):48-60.

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