准分子激光斑块消蚀术联合药物球囊干预股腘动脉支架再狭窄的疗效分析OACSTPCD

Objective To investigate the efficacy of excimer laser ablation(ELA)combined with drug-coated balloon(DCB)or plain old balloon(POBA)in the treatment of femoral-popliteal artery in-stent restenosis(FP-ISR).Methods Clinical data of 27 patients with FP-ISR were retrospectively analyzed,including 15 cases treated with ELA+DCB and 12 cases treated with ELA+POBA.The salvage stenting-free success rate,the incidence of complications and the changes of ankle brachial index(ABI)before and after surgery were observed in both groups.The primary patency rates were compared between the two groups.Results The stenotic segments of the stent were successfully opened in all patients.Three cases in each group received salvage stenting,and the salvage stenting-free success rates in ELA+DCB and ELA+POBA groups were 80.0％(12/15)and 75.0％(9/12),respectively.One case of distal embolism occurred in each group,and no vascular perforation,hematoma,pseudoaneurysm or death were observed in both groups.The postoperative ABI was significantly improved compared to that before the operation in two groups(P＜0.001).The primary patency rates at 3,6,and 12 months after surgery were 93.3％and 83.3％,86.3％and 66.7％,75.4％and 44.4％in the ELA+DCB and ELA+POBA groups,respectively(Log-rank test,x2=4.351,P=0.037).Multivariate Cox regression analysis showed that DCB is an independent protective factor for postoperative patency(HR=0.135,95％CI:0.023-0.782,P=0.025).Conclusion ELA combined with DCB or POBA are effective and safe for treatment of patients with femoropopliteal in-stent restenosis,while ELA combined with DCB may have higher patency rates in early and middle stages.