大脑中动脉重度狭窄病人Apollo支架植入术后再狭窄的影响因素及最佳受益人群分析

陈秀晓; 牛超; 贾倩; 董中君

doi:10.13898/j.cnki.issn.1000-2200.2023.08.013

大脑中动脉重度狭窄病人Apollo支架植入术后再狭窄的影响因素及最佳受益人群分析

Analysis of influencing factors and best beneficiaries of restenosis after stent implantation in patients with severe stenosis of MCA

摘要

摘要:
目的探讨大脑中动脉(MCA)重度狭窄病人Apollo支架植入术后再狭窄的影响因素及最佳受益人群。
方法回顾性选取MCA重度狭窄行Apollo支架植入术后病人142例进行研究。术后追踪随访1年, 按照MCA重度狭窄病人Apollo支架植入术后再狭窄发生情况分为无再狭窄组和再狭窄组。通过追踪随访检查病人再狭窄发生率, 治疗前后病人的神经功能缺损情况及日常生活活动状态, MCA狭窄段血流速度状况, 分析病人术后再狭窄影响因素。
结果经1年追踪随访病人Apollo支架植入术后再狭窄率为16.20%。治疗后病人的美国国立卫生研究院卒中量表评估低于治疗前, Barthel指数高于治疗前(P < 0.01)。治疗后病人的舒张末期血流速度及收缩期峰值血流速度均低于治疗前(P < 0.01)。无再狭窄组和再狭窄组病人形态学分型、径路分型差异有统计学意义(P < 0.05和P < 0.01), 再狭窄组吸烟率、2型糖尿病率、短暂性脑缺血发作率、术后残余狭窄率及重度病变狭窄率均高于无再狭窄组, 差异均有统计学意义(P < 0.05~P < 0.01)。吸烟、2型糖尿病、短暂性脑缺血发作、术后残余狭窄为术后发生再狭窄的危险因素(P < 0.01)。
结论MCA重度狭窄病人Apollo支架植入术可明显降低病人术后再狭窄的发生率及神经缺损状况, 提高病人的日常生活状态。形态学分型、径路分型、吸烟、2型糖尿病、短暂性脑缺血发作、术后残余狭窄及病变狭窄程度是术后再狭窄发生的影响因素, 其中吸烟、2型糖尿病、短暂性脑缺血发作、术后残余狭窄为术后再狭窄的预测因素, 无预测因素病人为Apollo支架植入术最佳受益人群。

Abstract:
ObjectiveTo investigate the influencing factors of restenosis after stent implantation in patients with severe stenosis of middle cerebral artery (MCA) and the analysis of the best beneficiary population.
MethodsA total of 142 patients with severe MCA stenosis were studied retrospectively.The patients with severe MCA stenosis diagnosed by computed tomography angiography or digital subtraction angiography were followed up for one year.The patients were divided into no restenosis group and restenosis group.The incidence of restenosis, neurological deficit and activities of daily living before and after treatment, blood flow velocity of MCA stenosis were followed up, and the influencing factors of postoperative restenosis were analyzed.
ResultsAfter one year follow-up, the restenosis rate was 16.20%.The National Institutes of Health stroke scale (NIHSS) after treatment was lower than that before treatment, and the Barthel index was higher than that before treatment (P < 0.01).The end diastolic blood flow velocity and peak systolic blood flow velocity after treatment were lower than those before treatment (P < 0.01).There were significant differences between the two groups in morphological classification, type of passage, smoking, type 2 diabetes, transient ischemic attack, postoperative residual stenosis and stenosis degree (P < 0.05 to P < 0.01).There was no significant difference in site classification, gender, age, hypertension, hyperlipidemia and coronary heart disease (P>0.05).By multivariate logistic regression analysis, smoking, type 2 diabetes, transient ischemic attack and postoperative residual stenosis were the risk factors for restenosis (P < 0.01).
ConclusionsApollo stent implantation in patients with severe stenosis of MCA can significantly reduce the incidence of restenosis and neurological deficit, improve the daily life of patients, improve blood flow speed.Morphological classification, pathway classification, smoking, type 2 diabetes, transient ischemic attack, postoperative residual stenosis and the degree of stenosis are the influencing factors for the occurrence of restenosis after surgery.Among them, smoking, type 2 diabetes, transient ischemic attack, postoperative residual stenosis are predictors of postoperative restenosis, and the patients without predictive factors are the best beneficiaries.

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