股動脈支架內再狹窄的介入處理

支架內再狹窄(in-stentrestenosis,ISR)就像就是支架得孿生兄弟一樣,從第一枚支架上市得那天起就一直伴隨著我們,就是我們前進得動力男性,63歲,左下肢間歇性脹痛伴跛行兩年余,加重十余天;高血壓史8年,吸煙30余年,30支/天男性,63歲,左下肢間歇性脹痛伴跛行兩年余,加重十余天;高血壓史8年,吸煙30余年,30支/天7個月后,癥狀復發再次行球囊擴張及溶栓治療5個月后,癥狀第2次復發第3次治療后

ISR發生機制血管損傷內皮細胞缺失(早期反應,數天內),血小板粘附,活化和聚集,血栓形成平滑肌細胞增殖(中期反應,數周內)細胞外基質沉積(延遲反應,數月內)臨床和影像學危險因素糖尿病,CLI,病變長度,TASCD,流出道差,嚴重鈣化等其她因素支架斷裂,支架設計,支架重疊釋放,鈣化病變支架未能充分釋放,遠端血管床流速慢,血管管徑小等ISR得治療傳統球囊POBA,CBA藥物洗脫球囊Drugelutingballoon切割球囊CuttingBalloon,PCBA冷凍球囊Cryoplasty球囊擴張Balloon傳統支架Baremetalstent藥物洗脫支架Drugelutingstent覆膜支架Endoprostheses支架成形術StentSilverhawkRotarexLaser-Atherectomy斑塊切除術Debulking旁路手術Bypass溶栓ThrombolysisISR:球擴+溶栓大家學習辛苦了，還是要堅持繼續保持安靜ISR:球囊擴張球囊擴張-CBAvs、CuttingBalloonDicketal、Radiology248;297-302,2008切割球囊球囊擴張-CBAvs、Cryoplasty76reinterventionswereperformedusingCBA(n=39)orcryoplasty(n=37)forin-stentrestenosiswithoutplacementofadditionalstentsThemeantimetorecurrentstenosisorneedforadditionalsecondaryinterventionwassignificantlyshorterforthecyroplastycohortthanfortheCBA,4、09and10、79monthsrespectively(P=、0001)Recurrentstenosis-freesurvivalwassignificantlylowerinthecyroplastycohortat3months(CBA:96、9%,Cyro:88、9%)and6months(CBA:84、0%,Cyro:43、8%;P=、0089)Cyroplastyasamodalityfortreatmentofin-stentstenosisinthefemoropoplitealsegmentoffersNObenefitoverCBAShinSH,etal、Vascular、2013,14DEB(DCB)39patientssinglecenterRegistryLesionlength:82、9±78、9mmCumulativeDEBlength:160mm(120–250)Stentlength:150mm(95–262、5)StabileE、JAmCollCardiol、2012;60:1739-42ISR:傳統支架(長期通暢率不高)ISR:傳統支架(長期通暢率不高)ISR:傳統支架(長期通暢率不高)ISR:傳統支架(長期通暢率不高)IS