肺静脉支架植入术后复发性狭窄的预后和处理：一项前瞻性研究。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-01-01 DOI:10.1016/j.jacep.2024.09.022

Xiaolei Wang MD , Jie Yu MD , Cheng Wang MD , Yanjie Li MD , Xumin Hou MD , Lan Ma MD , Ben He MD, PhD , Yunshan Cao MD, PhD , Xin Pan MD

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引用次数: 0

摘要

背景：肺静脉支架植入术是治疗严重肺静脉狭窄的有效方法，严重肺静脉狭窄受再狭窄限制。支架内再狭窄（ISR）的评估和管理不足，再干预后的随访结果仍然未知。目的：本研究旨在评估肺静脉ISR的预后和处理，并确定改良支架内支架策略是否优于球囊血管成形术（BA）治疗ISR。方法：作者对心房颤动射频消融后严重肺静脉狭窄患者进行前瞻性观察研究。结果：107例患者174条严重狭窄静脉成功置入支架。36例患者中43例静脉发生ISR（24.7%, 43 / 174）。发生ISR的静脉支架直径较小（7.8±0.8 mm vs 9.2±0.7 mm）；p = 0.008)。再狭窄静脉分为BA组和支架内支架组。BA的成功率为95.7%，支架内支架的成功率为90.0%。12条静脉复发ISR，其中支架内支架组2条（11.1%，18例中2例），BA组10条（45.5%，22例中10条）。支架内支架法治疗静脉狭窄复发的风险明显低于BA (HR: 0.21；95% ci: 0.07-0.64；p = 0.02)。与BA组相比，支架内支架组患者有更大的运动耐力和更好的世界卫生组织心功能分级(F = 7.2；P < 0.05；F = 4.4；P < 0.05)，随访6个月和12个月。结论：我们改良的支架内支架植入术治疗肺静脉ISR优于BA，可降低再狭窄复发率，提高运动耐力。

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Prognosis and Management of Recurrent Stenosis After Pulmonary Vein Stenting

Background

Pulmonary vein stenting is effective for severe pulmonary vein stenosis, which is limited by restenosis. The assessment and management of in-stent restenosis (ISR) are inadequate, and follow-up outcomes after reintervention remain unknown.

Objectives

This study aimed to assess the prognosis and management of pulmonary vein ISR and determine whether the modified stent-in-stent strategy is superior to balloon angioplasty (BA) in treating ISR.

Methods

The authors conducted a prospective observational study on patients with severe pulmonary vein stenosis post radiofrequency ablation for atrial fibrillation.

Results

A total of 107 patients with 174 severely stenosed veins underwent successful stenting. Forty-three veins among 36 patients experienced ISR (24.7%, 43 of 174). Veins developing ISR had smaller diameter stents (7.8 ± 0.8 mm vs 9.2 ± 0.7 mm; P = 0.008). Restenosis veins were assigned to BA group or stent-in-stent group. Success rate was 95.7% for BA and 90.0% for stent-in-stent. Twelve veins experienced recurrent ISR, including 2 in stent-in-stent group (11.1%, 2 of 18) and 10 in BA group (45.5%, 10 of 22). The risk of recurrent stenosis was significantly lower in veins treated with the stent-in-stent method than with BA (HR: 0.21; 95% CI: 0.07-0.64; P = 0.02). Patients in the stent-in-stent group had greater exercise endurance and better World Health Organization cardiac functional class compared with BA group (F = 7.2; P < 0.05; and F = 4.4; P < 0.05, respectively) at 6- and 12-month follow-ups.

Conclusions

Our modified stent-in-stent implantation approach is superior to BA for treating pulmonary vein ISR, by reducing recurrent restenosis rate and improving exercise endurance.

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.