下肢动脉硬化闭塞症患者腔内治疗术后支架内再狭窄的原因和治疗进展

Causes of in-stent restenosis following endovascular treatment in patients with lower extremity atherosclerotic occlusive disease and research progress in its treatment

摘要:

不断更新的镍钛合金支架使得下肢动脉硬化闭塞症(LEASO)患者的腔内治疗出现了革命性的改变,但仍有半数股腘动脉支架植入术患者出现支架内再狭窄(ISR)。ISR常见于长段复杂病变,原因和机制也较复杂,其治疗主要包括非手术治疗和血管再通治疗。非手术治疗包括戒烟、控制血糖、血脂、血压、抗凝、积极锻炼和药物治疗。血管再通治疗包括传统开放手术、Forgart导管取栓术、导管内接触性溶栓、经皮腔内血管成形术(PTA)、血管成形及支架植入术(PTAS)、经皮腔内斑块切除术、准分子激光斑块消蚀术(ELA)和血管腔内短距离放射治疗(EVBT)等。目前临床多采用复合治疗,以期取得更好的中远期疗效,降低再干预率,本文综述了ISR原因和血管再通治疗方面的研究进展。

Abstract:

In-stent restenosis (ISR) occurs in half of the patients treated with stenting of femoral and popliteal artery for lower extremity arteriosclerotic occlusive disease despite revolutionized treatment of lower extremity arteriosclerosis obliterans (LEASO) as a result of the continuous renewal of Ni-Ti alloy stent. ISR, occurring commonly at long and complicated lesions with complex causes and mechanisms, is treated non-surgically and with vascular recanalization. Non-surgical treatment includes quitting smoking, control of blood sugar, blood lipids and blood pressure, anticoagulation, and active exercise, and medication. Vascular recanalization consists of conventional open surgery, Forgart catheter thrombectomy, intraductal contact thrombolysis, percutaneous transluminal angioplasty (PTA), percutaneous transluminal angioplasty and stenting (PTAS), and percutaneous plaque resection, excimer laser atherectomy (ELA), and endovascular brachytherapy (EVBT). Combined therapy is mainly used clinically to obtain better medium- and long-term treatment outcomes and reduce the occurrences of reintervention. In this article, we reviewed the causes of ISR and research progress in vascular recanalization treatment.