椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素研究

摘要

目的：探讨椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素。方法选择沧州市人民医院2013年1月—2015年6月收治的椎动脉起始部粥样硬化性狭窄患者64例，均行血管内支架置入术并随访6个月，记录其性别、年龄、合并症、吸烟史、病变部位、术前椎动脉直径、支架类型、支架直径、支架长度及术后狭窄长度，分析血管内支架置入术后再狭窄的危险因素。结果所有患者顺利完成血管内支架置入术，随访期间18例出现再狭窄（再狭窄组），46例未出现再狭窄（无再狭窄组），再狭窄发生率为28.1%。两组患者性别、年龄、高血压发生率、糖尿病发生率、高胆固醇血症发生率、病变部位、支架直径、支架长度及术后狭窄长度比较，差异无统计学意义（P ﹥0.05）；再狭窄组患者吸烟史阳性率高于无再狭窄组，术前椎动脉直径短于无再狭窄组，采用药物支架者所占比例低于无再狭窄组（P ﹤0.05）。多因素 logistic 回归分析结果显示，有吸烟史〔β=0.098，OR =2.648，95%CI（1.159，4.674），P =0.001〕、术前椎动脉直径〔β=0.956，OR =2.614，95% CI（1.134，6.022），P =0.007〕为椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素，药物支架〔β=-0.612，OR =1.837，95% CI（1.086，4.597），P =0.029〕为保护因素。结论椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄发生率较高，有吸烟史、术前椎动脉直径为血管内支架置入术后再狭窄的危险因素，药物支架为保护因素。%Objective To investigate the risk factors of restenosis in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation. Methods A total of 64 patients with atherosclerotic vertebral artery origin stenosis were selected in the People's Hospital of Cangzhou from January 2013 to June 2015,all of them were treated by endovascular stent implantation and were followed up for 6 months. Clinical data including gender,age, complications,smoking history,diseased regions,preoperative diameter of vertebral artery,stent types,stent diameter,stent length and postoperative stenosis length was collected, and the risk factors of restenosis in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation were analyzed. Results All of the 64 patients successfully completed the endovascular stent implantation,thereinto 18 cases with restenosis were served as A group, other 46 cases without restenosis were served as B group,the incidence of restenosis was 28. 1% . No statistically significant differences of gender,age,incidence of hypertension,diabetes or hypercholesterolemia,diseased regions,stent diameter, stent length or postoperative stenosis length was found between A group and B group(P ﹥ 0. 05);positive rate of smoking history of A group was statistically significantly higher than that of B group,preoperative diameter of vertebral artery of A group was statistically significantly shorter than that of B group,while the proportion of patients using drug - eluting stent was statistically significantly lower than that of B group(P ﹤ 0. 05). Multivariate logistic regression analysis results showed that,smoking history〔β = 0. 098,OR = 2. 648,95% CI(1. 159,4. 674),P = 0. 001〕,preoperative diameter of vertebral artery〔β = 0. 956,OR = 2. 614,95% CI(1. 134,6. 022),P = 0. 007〕 were risk factors of restenosis in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation,while drug - eluting stent was the protective factor〔β= - 0. 612,OR = 1. 837,95% CI(1. 086,4. 597),P = 0. 029〕. Conclusion The incidence of restenosis is relatively high in postoperative patients with atherosclerotic vertebral artery origin stenosis treated by endovascular stent implantation,smoking history and preoperative diameter of vertebral artery are the risk factors,while drug - eluting stent is the protective factor.