锁骨下动脉闭塞血管内再通治疗的可行性分析

doi:10.3969/j.issn.1673-5765.2021.09.011

摘要/Abstract

摘要： 目的探讨慢性锁骨下动脉闭塞血管内再通治疗的可行性、安全性与有效性。方法回顾性分析2014年1月-2018年6月首都医科大学附属北京天坛医院神经介入中心收治的慢性锁骨下动脉完全闭塞且存在病变侧上肢远端肢体乏力等缺血症状或明确诊断为锁骨下动脉盗血综合征（subclavian steal syndrome，SSS）患者的临床资料。分析血管内治疗慢性锁骨下动脉闭塞的血管再通成功率、围手术期并发症（30 d内缺血性卒中、心肌梗死和血管性死亡）及术后血管再狭窄等指标。根据血管内治疗后闭塞的锁骨下动脉开通结果分为成功再通组及再通失败组，比较两组一般资料和临床特点。根据成功再通组患者所用支架类型分为自膨式支架组和球扩式支架组，比较两组术后血管残余狭窄率的差异。对成功再通的患者进行随访，根据是否出现术后血管再狭窄分为术后再狭窄组和无术后再狭窄组，比较两组的一般资料和临床特点。结果共纳入106例符合入组标准的患者，男性87例（82.1%），女性19例（17.9%），中位年龄61.0 （56.8～67.0）岁。有91例（85.9%）血管成功再通，15例（14.2%）血管再通失败，成功再通组及再通失败组的人口学信息、既往史、发病到治疗时间等临床特征差异无统计学意义。所有患者均无围手术期并发症发生。成功再通组35例（38.5%）采用自膨式支架，56例（61.5%）患者采用球扩式支架，自膨式支架组和球扩式支架组术后中位残余狭窄率分别为10.0%（10.0%～16.3%）和10.0% （5.0%～10.0%），差异无统计学意义。成功再通组中有85例（93.4%）完成术后3个月到1年的随访并进行了CTA或DSA检查，随访中位时间为13.0（6.0～15.0）个月，术后再狭窄5例（5.9%），无术后再狭窄 80例（94.1%），术后再狭窄组较无术后再狭窄组的中位年龄更高（64.0岁 vs 59.5岁，P =0.027）。结论血管内再通治疗是治疗慢性锁骨下动脉闭塞的一种安全有效的方法。

文章导读： 本研究旨在分析血管内介入治疗在慢性锁骨下动脉完全闭塞患者中的安全性和有效性。研究结果表明，血管内介入治疗可作为该类疾病的治疗方式选择，具有成功率高、并发症少、疗效佳的优点。

关键词: 锁骨下动脉盗血综合征; 锁骨下动脉闭塞; 血管内治疗; 支架; 神经影像

Abstract: Objective To investigate the feasibility, safety and effectiveness of endovascular recanalization for chronic subclavian artery occlusion. Methods The data of patients with chronic subclavian artery occlusion and ischemic symptoms of the ipsilateral distal upper extremity or a clear diagnosis of subclavian steal syndrome (SSS) from Neurointervention Center of Beijing Tiantan Hospital between January 2014 to June 2018 were retrospectively analyzed. The rate of successful recanalization, perioperative complications (ischemic stroke, myocardial infarction and vascular death within 30 days), and postoperative restenosis were systematically analyzed. According to the results of recanalization, patients were

divided into successful recanalization group and recanalization failure group, and the clinical

characteristics of the two groups were compared. According to the stent types used in the successful recanalization group, the patients were divided into the self-expanding stent group and balloonmounted stent group, and the difference in residual stenosis rate between the two groups was compared. The patients in the successfully recanalization group were all followed up. According to the follow-up vascular imaging, the patients were divided into those with or without restenosis, and the clinical characteristics of the two groups were compared. Results A total of 106 patients were enrolled, including 87 males (82.1%) and 19 females (17.9%), with a median age of 61.0 (range: 56.8-67.0) years old. There were 91 cases (85.9%) with successful recanalization and 15 cases (14.2%) with failed recanalization. There was no statistical difference in clinical characteristics including demographic information, medical history, time from onset to treatment between the successful recanalization group and recanalization failure group. No perioperative complications occurred in all the patients in this study. In the successful recanalization group, 35 cases (38.5%) were treated with self-expanding stents, and 56 cases (61.5%) with balloon-mounted stents. The median residual stenosis rate was 10.0% (10.0%-16.3%) in the self-expanding stent group and 10.0% (5.0%-10.0%) in the balloon-mounted stent group, without statistical difference between the two groups. In the successful recanalization group, 85 cases (93.4%) were followed up for 3 months to 1 year and underwent CTA or DSA, with a median follow-up time of 13.0 (6.0-15.0) months. Restenosis occurred in 5 (5.9%) of the 85 patients. The median age of the patients with restenosis was higher than that of ones without restenosis (64.0 years vs 59.5 years, P =0.027). Conclusions Endovascular recanalization is a safe and effective treatment for chronic subclavian artery occlusion.

Key words: Subclavian steal syndrome; Subclavian artery occlusion; Endovascular recanalization; Stent; Neuroradiological

孙勇, 杨波, 康开江, 高峰, 莫大鹏, 缪中荣, 马宁. 锁骨下动脉闭塞血管内再通治疗的可行性分析[J]. 中国卒中杂志, 2021, 16(09): 940-945.

SUN Yong, YANG Bo, KANG Kai-Jiang, GAO Feng, MO Da-Peng, MIAO Zhong-Rong, MA Ning. Feasibility Analysis of Endovascular Recanalization for Subclavian Artery Occlusion[J]. Chinese Journal of Stroke, 2021, 16(09): 940-945.

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