临床医学支架植入术后的延迟预后几何因素限制作用课件.ppt

Determinants of Restenosis Residual stenosis Residual gradient Stenting characteristics: Configuration Stent design and material Minimum diameter, stents number, stented length transverse dead-space (radial mismatch) Protrusion mismatch Gender Age Cardiovascular risk factors Use of ADP-inhibitor antiplatelet agents Disease pattern: TASC class Total occlusion Lesion length Vessel diameter Outflow score Geometric Mismatch- Determinants: Aortic diameter Aortic anatomy Stent sizing Stent material Effect of Size and Stent Material on Geometric Mismatch Effect of Aortic Anatomy on Optimal Stenting Patterns Optimal Geometry:Oversized, Nitinol, Straight Aorta Univariate Predictors of Restenosis Odds Ratio Confidence Interval P Radial Mismatch 5.87 2.44 - 14.14 0.02 Female Gender 3.75 1.78 - 7.89 0.05 Prior Occlusion 2.85 1.12-8.22 0.06 Residual stenosis/ gradient 6.0 2.48 - 14.04 0.02 Multivariate Logistic Regression: Radial mismatch: OR: 13.0 (0.94-109.7), P=0.05 Prior occlusion: OR: 8.2 (0.84-70.8), P=0.06 Female: OR: 3.9 (3.9-28.1), P=0.1 suboptimal number of restenoses 48 yo woman with debilitating bilateral claudication Distal aorta and bilateral CIA occlusion Recanalization, primary stenting(crossing wallstents), and post-dilation Persistent 32 mmHg systolic pressure gradient with sluggish flow Management: Balloon Fenestration Recurrent right sided symptoms 31 months later Lesion Restented: Patient remains Sx-free 51 mos post-procedure Drawbacks Retrospective Analysis Single-institution Limited statistical power due to numbers of restenosis (9 patients) Heterogeneous follow-up modalities (limitation of non-invasive methods) Important Conclusions Long-term follow-up Excellent primary and primary-assisted patency rates in surviving patients Amenability of complex aortoiliac occlusive disease to long-term patency (including long segment and bilateral occlusions) Insight on potential role of geometric and determinants on long-term patency High inherent mortali