Post-Stent Vein Lumen Shape and Clinical Response in Patients Treated for Iliofemoral Venous Occlusive Disease.

Paul Gagne, Kayode O Kuku, Robert Mendes, Amy Griggs, Edem Segbefia, Lawrence V Hofmann, Anthony Comerota, Hector M Garcia-Garcia
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Abstract

Objective: Interventionalists have noted significant venous luminal gain with nitinol venous stents although post-placement lumen shape differed from the circular shape observed with elgiloy stents. The goal of this study was to determine the characteristics of a stented vein lumen that correspond with clinical outcomes, and to identify metrics that might be relevant for stent design by assessing aspect ratio (AR), lumen diameter (LD), lumen area (LA), and stent shape (symmetry and eccentricity) post-implant.

Methods: This post-hoc analysis evaluated patients from the VIVO US Study (NCT01970007) with pre- and post-stent intravascular ultrasound (IVUS) imaging. Patient characteristics, Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS) were collected in the study. LD, LA, and stent geometry were measured by the core laboratory. Data were analyzed for linear association between core-laboratory assessed pre and post stent LD, LA, AR, stent eccentricity and symmetry index, and VCSS and VDS change.

Results: IVUS imaging was available for 29 patients (2 sites) enrolled in the VIVO US Study (55.2% women; mean age: 59.8 ± 17 years). The cohort had post-thrombotic (48.3%), nonthrombotic iliac vein lesion (44.8%) or acute deep vein thrombotic (6.9%) disease. Mean lesion length was 111.8 ± 60.9 mm. Eleven stents extended below the inguinal ligament. Median minimum LD and LA significantly increased after stent placement (P < 0.001); median lumen AR changed from 2.0 pre-stent to 1.4 post-stent (P < 0.001). Mean VCSS improved from baseline to 12 months (7.6 ± 4.3 to 3.7 ± 2.6). No statistically significant linear relationships were identified between VCSS / VDS change and a specific characteristic of LA, LD, or AR.

Conclusions: Measures of lumen change pre and post iliofemoral vein nitinol stent placement reflect disease and stent characteristics. After stent placement, minimum LD and LA increased and AR decreased. Stented lumen shape or size with Zilver Vena did not impact 1-year clinical improvement by VCSS.

目的:介入专家注意到镍钛诺静脉支架能显著增加静脉管腔,但置入后的管腔形状与使用埃吉洛伊支架观察到的圆形不同。本研究的目的是确定与临床结果相对应的支架静脉管腔特征,并通过评估支架植入后的长宽比(AR)、管腔直径(LD)、管腔面积(LA)和支架形状(对称性和偏心率),确定可能与支架设计相关的指标:这项事后分析评估了 VIVO US 研究 (NCT01970007) 患者支架植入前后的血管内超声 (IVUS) 成像。研究收集了患者特征、静脉临床严重程度评分(VCSS)和静脉残疾评分(VDS)。核心实验室对 LD、LA 和支架几何形状进行了测量。对数据进行分析,以确定核心实验室评估的支架前后LD、LA、AR、支架偏心率和对称性指数以及VCSS和VDS变化之间的线性关系:参加 VIVO US 研究的 29 名患者(2 个地点)(55.2% 为女性;平均年龄:59.8 ± 17 岁)均获得了 IVUS 成像。这些患者有血栓后(48.3%)、非血栓性髂静脉病变(44.8%)或急性深静脉血栓(6.9%)疾病。病变平均长度为 111.8 ± 60.9 毫米。有 11 个支架延伸至腹股沟韧带以下。支架置入后,中位最小LD和LA明显增加(P < 0.001);中位管腔AR从支架置入前的2.0变为支架置入后的1.4(P < 0.001)。平均 VCSS 从基线到 12 个月有所改善(7.6 ± 4.3 到 3.7 ± 2.6)。VCSS/VDS变化与LA、LD或AR的特定特征之间未发现有统计学意义的线性关系:结论:髂股静脉镍钛诺支架置入前后的管腔变化反映了疾病和支架的特征。放置支架后,最小 LD 和 LA 增加,AR 减少。使用 Zilver Vena 支架的管腔形状或大小不会影响 VCSS 1 年的临床改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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