支架内再狭窄分型英文资料下载.pdf

支架内再狭窄分型英文资料下载.pdf

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Factorspredictingin-stentrestenosis（ISR）andfutureneedfortargetlesionrevascularization（TLR）aftercarotidarterystenting（CAS）remainundetermined.Wehypothesizedthatthepatternsofrestenoticlesionsmayprovideprognosticinformation.Inthisstudy,wedevelopedanultrasoundclassificationschemeforISRbasedonlesionlengthanddistributionandassessedfactorsthatmaypredicttheneedforTLR.Methods:

PatientswerefollowedupafterCASwithB-modeultrasoundimaging,andISRlesions（40%stenosis）wereclassifiedintotypeI（focal10mmend-stentlesions）,II（focal10mm,intrastent）,IV（diffuse10mmproliferative,extendingoutsidethestent）,andV（totalocclusion）.Thefrequencyoflesiontypeswasassessed.Accuracyoftheultrasoundclassificationwasconfirmedwithangiography.Werecordedpatient（age,gender,comorbidities）,lesion（severity,etiology,symptomaticstatus）andproceduralfeatures（type,number,lengthofstents）,andtheneedforTLR.Results:

Eighty-fiveISRlesionsdevelopedafter255CASprocedures.TheirpercentagedistributionwastypeI,40;

typeII,25.9;

typeIII,12.9;

fortypeIV,20;

andtypeV,1.2.Accuracyoftheultrasoundclassificationwasconfirmedbyangiography（r2?

0.82）.Inter-rateragreementfortheassignmentoflesiontypebasedonultrasoundwas0.88（verygood）.TLRwasperformedin13thatwere80%diameterreducing.Onunivariateanalysis,theneedforTLRwashighestintypeIVlesions（0%,0%,27.3%,and58.8%typesItoIV,respectively;

P?

.001）.HistoryofISR（2.9%,0%,0%,and41.2%typesItoIV;

.003）anddiabetesmellitus（20.6%,22.7%,45.5%,and52.9%typesItoIV;

.02）occurredmorefrequentlywithtypeIVISRlesions.Onmultivariateanalysisofallpatient,lesion,andproceduralcharacteristics,onlythetypeofISR（oddsratio,5.1）andahistoryofdiabetes（oddsratio,9.7）wereindependentpredictorsofTLR.Conclusions:

TheproposedclassificationaccuratelygradesthemagnitudeofintimalhyperplasiaafterCASandprovidesimportantprognosticinformation.Diffuseproliferative（typeIV）ISRlesionsanddiabetesareimportantdeterminantsoflong-termoutcomeafterCAS.ThisclassificationwillfacilitateastandardizeddescriptionofrecurrenceafterCASandenableearlyidentificationofhigh-riskpatientsforadditionalmonitoring,treatment,andinvestigation.（JVascSurg2007;

46:

833-40.）Carotidarterystenting（CAS）hasemergedasalessinvasivealternativetocarotidendarterectomy（CEA）forrevascularizationofextracranialcarotidocclusivedisease.Ourinstitution1-5andothers6-10havereportedthatCAScanbeperformedwithlowperiproceduralmorbidity.Onlong-termfollow-up,wehaveobservedin-stentrestenosis（ISR）of?

40%diameterreductionin42.7%ofourpatients,andof?

60%diameterreductionin16.4%at5yearsoffollow-up.5Similarly,theStentingandAngioplastywithProtectioninPatientsatHighRiskforEndarterectomy（SAPPHIRE）investigatorsreportedISRin19.7%ofpa-tientsat1yearoffollow-up.11Therefore,ISRwillbecomeincreasinglyprevalentduetotheexponentialincreaseintheuseofcarotidstents.Post-CASISRiscurrentlytreatedatathresholdof?

80%diameterreduction（6.4%incidenceat5years5）.However,factorsthatpredicttargetvesselfailureremainundetermined.Primarystentingpreventscarotidarteryrecoilandconstrictiveremodeling.12Post-CASISRcanthreforebeprimarilyattributedtoneointimalhyperpla-sia,12,13andstudiesofcoronaryISRindicatethatlongneointimalhyperplasialesionsdiffuselyinvolvingthestentsurfacecorrelatewiththehighestrecurrenceandreinter-ventionrates.14FromtheDivisionofVascularSurgerya,DepartmentofPhysiologyb,andDepartmentofBiomedicalEngineeringc,UniversityofMedicineandDentistry,NewJersey-NewJerseyMedicalSchool;

theDivisionofVas-cularSurgery,St.MichaelsMedicalCenterd;

andtheDivisionofVascularSurgery,UniversityofAthense.Competitionofinterest:

none.SupportedbygrantsfromtheAmericanHeartAssociation（RA5883,BKL）andtheNationalInstitutesofHealth（NS38384,RWH）.PresentedatVASCULAR2007,AnnualMeetingoftheSocietyforVascularSurgery,Baltimore,Md,June7-10,2007.Reprintrequests:

BrajeshKLal,MD,UMDNJ-NewJerseyMedicalSchool,185SOrangeAve,MSB-H570,Newark,NJ07103（e-mail:

lalbkumdnj.edu）.0741-5214/$32.00Copyright2007byTheSocietyforVascularSurgery.doi:

10.1016/j.jvs.2007.07.022833ThepatternsofISRdevelopingaftercarotidarterystentinghavenotbeendescribed,andtheirprognosticutilityhasnotbeenstudied.Wethereforedevelopedanultrasoundclassificationschemeforpost-CASISRbasedonthelengthanddistributionofthelesionwithrespecttothestentandverifieditsaccuracywithcarotidangiography.Weth