【摘要】 目的 探究达标的管腔预处理对下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）患者药物洗脱支架（drug-eluting stents,DES）12个月一期通畅率的影响，并分析支架内再狭窄的独立预测因素。方法 采用回顾性队列研究设计，纳入2022年4月至2024年4月在重庆医科大学附属第一医院血管外科接受DES治疗的141例ASO患者为研究对象。根据经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）后血管夹层分级（国家心肺血液研究所，C型及以上为严重夹层）及残余狭窄率（≥30%为重度狭窄），将不存在严重夹层和重度残余狭窄的患者纳入达标组（n=59），其余患者纳入未达标组（n=82）。采用彩色多普勒血管超声或血管造影评估DES 12个月一期通畅率，通畅的标准定义为血管超声收缩期峰值流速比≤2.4或血管造影狭窄<50%。采用Kaplan-Meier法比较组间DES通畅率及无临床驱动的靶病变血运重建（clinically driven target lesion revascularization,CD-TLR）率差异。采用多因素Logistic回归分析DES再狭窄的危险和保护因素，评估PTA后夹层和残余狭窄对DES再狭窄的风险贡献度。结果 PTA后94.3%(133/141)的患肢出现血管夹层，其中42.1%(56/133)为严重夹层；44.0%(62/141)存在重度管腔残余狭窄。Kaplan-Meier生存分析显示，达标组DES 12个月一期通畅率显著高于未达标组（HR=0.322,95%CI:0.132～0.789,P=0.013），而无CD-TLR率组间差异无统计学意义（HR=0.608,95%CI:0.187～1.937, P=0.407）。多因素Logistic回归分析显示，达标的管腔预处理（OR=0.228,95%CI:0.069～0.747,P=0.015）和Rutherford分类2～3类（OR=0.205,95%CI:0.058～0.725,P=0.014）是DES再狭窄的独立保护因素。严重夹层与重度残余狭窄共存组的DES通畅率显著低于无并发症组（P<0.001），且再狭窄风险达无并发症组的7.067倍（P<0.001）。结论 达标的管腔预处理可有效改善DES 12个月一期通畅率，并与Rutherford分类2～3类为支架内再狭窄的独立保护因素，术中应竭力避免同时出现严重夹层与重度残余狭窄。更多还原

【Abstract】 Objective To investigate the impact of adequate lumen preparation on the 12-month primary patency rate of drug-eluting stents(DES) in patients with lower extremity arteriosclerosis obliterans(ASO) and to identify risk and protective factors for in-stent restenosis. Methods A retrospective cohort study was conducted on 141 patients who underwent DES implantation for ASO at the Department of Vascular Surgery of the First Affiliated Hospital of Chongqing Medical University between April 2022 and April 2024. According to post-percutaneous transluminal angioplasty(PTA) dissection grade [severe dissection is defined as type C or higher based on National Heart, Lung, and Blood Institute(NHLBI) criteria] and residual stenosis rate(severe stenosis is defined as ≥30%), the patients were categorized into an adequate preparation group(no severe dissection or severe residual stenosis; n=59) and an inadequate preparation group(n=82). DES primary patency at 12 months was assessed by color Doppler ultrasonography or angiography, defined as a peak systolic velocity ratio ≤2. 4 on duplex ultrasound or angiographic stenosis <50%. Kaplan-Meier analysis was used to compare intergroup differences in DES patency rate and freedom from clinically driven target lesion revascularization(CD-TLR). Multivariate logistic regression analysis was employed to identify risk and protective factors for DES restenosis and to evaluate the risk contributions of post-PTA dissection and residual stenosis to DES restenosis. Results Post-PTA, vascular dissection occurred in 94. 3%(133/141) of treated limbs, among which 42. 1%(56/133) were severe dissections, and severe residual stenosis was present in 44. 0%(62/141) of limbs. Kaplan-Meier analysis revealed that the 12-month primary patency rate was significantly higher in the adequate preparation group than the inadequate group(HR=0. 322, 95%CI: 0. 132～0. 789, P=0. 013), while no significant difference was found in the rate of freedom from CD-TLR(HR=0. 608, 95%CI: 0. 187～1. 937, P=0. 407). Multivariate logistic regression analysis identified adequate lumen preparation(OR=0. 228, 95%CI: 0. 069～0. 747, P=0. 015) and Rutherford category 2～3(OR=0. 205, 95%CI: 0. 058～0. 725, P=0. 014) as independent protective factors against DES restenosis. The patency rate in the subgroup with coexisting severe dissection and residual stenosis was significantly lower than that in the uncomplicated group(55. 6% vs 89. 8%, P<0. 001), with a 7. 067-fold increased risk of re-stenosis(95%CI: 2. 424～20. 602, P<0. 001). Conclusion Adequate lumen preparation significantly improves the 12-month primary patency rate of DES. It, along with Rutherford category 2～3, serves as an independent protective factor against in-stent restenosis. Concurrent severe dissection and significant residual stenosis should be actively avoided during the procedure.更多还原