■尽管肾支架置入术是动脉粥样硬化性肾动脉狭窄(RAS)(FMD-RAS)的标准血运重建方法,纤维肌性发育不良(FMD)RAS的支架置入术通常限于血管成形术和原发性动脉夹层的围手术期并发症.该研究的主要目的是回顾性分析FMD患者的肾脏支架置入术与血管成形术的近期和长期结果。
■在ARCADIA-POL注册的343名患者中,58例患者因FMD-RAS(70支动脉)接受了经皮治疗。经皮腔内肾动脉成形术(PTRA)作为61条动脉的初始治疗(PTRA组),而在9条动脉(支架组)中进行了主要支架置入术。支架相关并发症定义为:支架内再狭窄>50%(ISR);支架骨折;扩张不足;或迁移。
■在PTRA组中,初次再狭窄率为50.8%。然后在22条动脉中进行第二次手术:re-PTRA(12条动脉)或支架(10条动脉)。re-PTRA术后再狭窄的发生率为41.7%。通过支架置入二次治疗的10条动脉中有7条(70%)发生并发症:2条扩张不足,5条ISR。在支架组中,1例(11.1%)发生支架扩张不足,3例(33.3%)发生ISR。在支架动脉的综合分析中,主要或次要,支架相关并发症发生在11/19支架术中(57.9%):3起因扩张不足,8起因ISR。最后,尽管有几次血运重建尝试,随访成像时,19条支架动脉中有4条(21%)完全闭塞,1条明显狭窄.
■我们的研究表明,FMD-RAS中的肾脏支架置入术可能会带来晚期并发症的高风险,包括支架闭塞。需要来自大规模登记册的更多观测数据。
Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the
study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD.
Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration.
In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging.
Our
study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required.