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1、解放军总医院血管外科解放军总医院血管外科贾鑫、郭伟、刘小平、尹太、熊江、马晓辉等贾鑫、郭伟、刘小平、尹太、熊江、马晓辉等vasc 如何应对支架内再狭窄证据及展望如何应对支架内再狭窄证据及展望 血管外科医生最头痛血管外科医生最头痛的问题的问题 开刀移植物闭塞开刀移植物闭塞 腔内支架内再狭腔内支架内再狭窄窄ISRISR支架内再狭窄支架内再狭窄ISRISR：In-Stent RestenosisIn-Stent Restenosis病理：几乎全部内膜增生病理：几乎全部内膜增生病因：病变部位、病变长度、支架数量、流病因：病变部位、病变长度、支架数量、流入流出道入流出道支架断裂能够缘由，呵斥血管壁回缩和
2、支架断裂能够缘由，呵斥血管壁回缩和刺激内膜增生刺激内膜增生抗血小板药物降低抗血小板药物降低ISRISR？PTA plus(or)Stent Atherectomy Laser Stentgraft DES or DEB CryoplastyPTA+STENT 再狭窄率再狭窄率颈动脉颈动脉5肾动脉肾动脉1020髂动脉髂动脉520腹股沟以下动脉腹股沟以下动脉2550Zellar etc,Cath Cardiovasc Interv,2007,70SFA易再狭窄易再狭窄途径途径长长，侧侧支少支少内收肌管内收肌管挤压挤压闭闭塞多于狭窄塞多于狭窄 SFA裸支架通裸支架通畅畅率率(Freedom from
3、 TLR)Dorrucci J Vasc Surg,Aug 2004 PTA plus(or)Stent Atherectomy Laser Stentgraft DES or DEB CryoplastyAtherectomy dataSFA病病变变，22%闭闭塞，塞，18狭窄，平均狭窄，平均长长度度46mm24月随月随访访，84例例ABI术术前前0.62，术术后后0.84，随，随访访0.721年通年通畅畅率率91%,2年通年通畅畅率率80 Zellar etc,J Endo Ther,2007 ApriLACILaser Assisted Angioplasty for Critical
4、Limb Ischemia 127人，随访6月SFA病变，平均长度38mmFree from TLR 85%J Laird,etc J Vasc Surg,2007,AugCryoplasty-Big CHILL trialProspective multicenter registry诱导诱导VSMC凋亡凋亡,弹弹力力纤维变纤维变性，从而减少性，从而减少弹弹性回性回缩缩录录入入102患者，患者，SFA长长度度48mm,狭窄病狭窄病变变9月随月随访访，通，通畅畅率率72Laird J etc,J vasc interv radiol 2005,Feb Covered stent for SFA
5、 J Vasc Surg,2007,May DES for SFA M Dake,Charing cross 2021,May,presentation BTK drug eluting stent trial J Endo Ther,2005,Dec J Cardio Surg,2007,ApriDrug coated balloon(Thunder trial)6 month follow-upMean 65mm,SFAT Das,2021 VIVA presentation PTA plus(or)Stent：直径、：直径、长长度度 Atherectomy Laser Stentgraf
6、t Cryoplasty DES or DEB腔内治疗腔内治疗ISRISRPTAPTASTENTSTENTCutting balloonCutting balloonBrachytherapyBrachytherapyLaserLaserStentgraftStentgraftDES or DEBDES or DEBCutting balloon31 patients 36 lesions,CLILength 32.4mmPrimary patency 61%6 monthLimb salvage 83%Bosiers M etc,vascular,2021,FebLaser/PTA+支架血管
7、支架血管39人，人，SFA,ISRRutherford Class 1-6,mean 3病病变变平均平均长长度度 27cm,(5-44cm)Gary ansel J Vasc Surg,2021,May6月随月随访访Primary patency 73%Primary assisted patency 76%Occluded 24%18月随月随访访Primary patency 52%Primary assisted patency 67%Brachytherapy13例例肾动肾动脉支架脉支架术术后后ISRPTA+brachytherapy(12Gy Gamma)结结果果:80通通畅畅率率12月月Stoeteknuel etc J Endo Therapy,2002 Zellar etc,Cath Cardiovasc Interv,2007,70 PTASTENT Cutting balloon Brachytherapy Laser Stentgraft DES or DEB
如何应对支架内再狭窄证据及展望ppt课件
