如应对支架内再狭窄－－证据及展望

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 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、流入流出道病因：病变部位、病变长度、支架数量、流入流出道支架断裂可能原因，造成血管壁回缩和

2、刺激内膜增生支架断裂可能原因，造成血管壁回缩和刺激内膜增生 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 路径长，侧支路径长，侧支少少 内收肌管挤压内收肌管挤压 闭塞多于狭窄闭塞多于狭窄 sfa裸支架通畅率裸支架通

3、畅率(freedom from tlr)dorrucci j vasc surg, aug 2004 pta plus (or) stent atherectomy laser stentgraft des or deb cryoplastyatherectomy data sfa病病变变，22%闭闭塞，塞， 18狭窄，平均长度狭窄，平均长度46mm 24月随访，月随访，84例例 abi术前术前0.62，术后术后0.84，随访随访0.72 1年通畅率年通畅率91%, 2年通畅率年通畅率80 zellar etc, j endo ther, 2007 aprilaci（laser assiste

4、d angioplasty for critical 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 trial prospective multicenter registry 诱导诱导vsmc凋亡凋亡, 弹力纤维变性，从而减少弹性回缩弹力纤维变性，从而减少弹性回缩 录入录入102患者，患者，sfa长长度度48mm, 狭窄病变狭窄病变 9月随访，通畅率月随访，通畅率72laird j etc, j vasc inte

5、rv radiol 2005, feb covered stent for sfaj vasc surg, 2007, may des for sfam dake, charing cross 2009, may, presentation btk drug eluting stent trialj endo ther, 2005, decj cardio surg, 2007, apridrug coated balloon(thunder trial) 6 month follow-up mean 65mm, sfat das, 2009 viva presentation pta plu

6、s (or) stent：直径、长度直径、长度 atherectomy laser stentgraft cryoplasty des or deb腔内治疗腔内治疗isrisr ptastent cutting balloon brachytherapy laser stentgraft des or debcutting balloon 31 patients 36 lesions, cli length 32.4mm primary patency 61% 6 month limb salvage 83%bosiers m etc, vascular, 2009, feblaser/pta

7、+支架血管支架血管 39人，人，sfa, isr rutherford 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, 2009, may6月随访月随访 primary patency 73% primary assisted patency 76% occluded 24%18月随访月随访 primary patency 52% primary assisted patency 67%brachytherapy 13例肾动脉支架术后例肾动脉支架术后isr pta+brachytherapy(12gy gamma) 结果结果:80通畅率通畅率12月月stoeteknuel etc j endo therapy,20