支架设计与颈动脉支架置入术后斑块内新生血管形成的关系探讨

Relationship between Stent Design and Intra-Plaque Neovascularization after Carotid Artery Stenting

摘要: 目的：利用超声造影技术(contrast-enhanced ultrasound, CEUS)探讨支架设计与颈动脉支架置入后斑块内新生血管形成(intra-plaque neovascularization, IPN)的关系，进而分析支架设计对颈动脉支架成形术后支架内再狭窄(in-stent restenosis, ISR)的影响。方法：纳入2020年7月至2021年1月在青岛大学附属医院神经介入科行支架治疗颈动脉狭窄的患者58例，于术前1周、术后1个月、3个月、6个月行CEUS随访检查，根据支架设计类型分为开环支架组与闭环支架组，分析支架设计与IPN的相关性，并比较两组术后ISR的发生率。结果：闭环支架组26例，开环支架组32例，随访期间累计5例IPN等级发生改变，均为1级进展至2级，两组术后6个月IPN分级例数比较有统计学意义(P = 0.048)。支架设计与IPN分级存在线性关系(X² = 3.834, P = 0.047)，且呈负相关(r = −0.259, P = 0.021)。闭环支架组发现1例ISR (3.85%, 1/26)，开环支架组未发现明显ISR，两组ISR发生率比较无统计学意义(P > 0.05)。结论：支架设计与颈动脉支架术后IPN存在一定的相关性，而支架设计对ISR的影响则有待进一步的研究。

Abstract: Objective: To investigate the relationship between stent design and intra-plaque neovascularization (IPN) after carotid artery stenting with contrast-enhanced ultrasound (CEUS), in order to analyze the influence of stent design on in-stent restenosis (ISR). Methods: A total of 58 patients who underwent carotid artery stenting from July 2020 to January 2021 in the Department of Neurointervention of the Affiliated Hospital of Qingdao University, were followed up by CEUS at 1 week before surgery, 1 month, 3 months and 6 months after surgery. The stent design was divided into open-cell stents and closed-cell stents. Then the correlation between stent design and IPN was analyzed, and the incidence of ISR between them compared. Results: Closed-cell stents (N = 26), open-cell stents (N = 32). During the period, 5 cases had changed from Grade 1 to Grade 2 in IPN. There was a statistical significance in comparing with IPN grades of two groups at 6 months after operation (P = 0.048). There was a linear relationship between stent design and IPN classification (X² = 3.834, P < 0.05), and that was a negative correlation (r = −0.259, P < 0.05). One ISR was found in the closed-cell stents, and no ISR in the open-cell stents (P < 0.05). Conclusion: There is a certain correlation between stent design and IPN after carotid artery stenting, while the influence of stent design on ISR needs further study.