[1]李洋①李天润**靳亚①.血管钙化程度与药物涂层球囊治疗下肢动脉支架内再狭窄预后的相关性分析[J].中国微创外科杂志,2026,01(6):321-328.
　Li Yang,Li Tianrun,Jin Ya..Correlation Analysis of Vascular Calcification Degree and Prognosis of Drugcoated Balloon Treatment for Instent Restenosis of Lower Extremity Arteries[J].Chinese Journal of Minimally Invasive Surgery,2026,01(6):321-328.
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血管钙化程度与药物涂层球囊治疗下肢动脉支架内再狭窄预后的相关性分析()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年6期
页码:
321-328
栏目:
临床论著
出版日期:
2026-06-22

文章信息/Info

Title:
Correlation Analysis of Vascular Calcification Degree and Prognosis of Drugcoated Balloon Treatment for Instent Restenosis of Lower Extremity Arteries
作者:
李洋①李天润**靳亚①
(北京大学第三医院介入血管外科，北京100191)
Author(s):
Li Yang;  Li Tianrun;  Jin Ya.
Department of Interventional Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
关键词:
支架内再狭窄; 钙化病变; 药物涂层球囊; 再狭窄; 疗效; 影响因素
Keywords:
Instent restenosis; Calcified lesion; Drugcoated balloon; Restenosis; Efficacy; Influencing factor
文献标志码:
A
摘要:
目的探讨血管钙化程度与药物涂层球囊(drugcoated balloon，DCB)治疗下肢动脉支架内再狭窄(instent restenosis，ISR)后再狭窄的相关性。方法采用回顾性队列研究，最终纳入2019年1月~2023年3月北京大学第三医院DCB治疗126例ISR。结局指标为1年随访期内影像学复查定义的再狭窄。采用外周动脉钙化评分系统(Peripheral Artery Calcification Scoring System，PACSS)评估ISR病变部位血管钙化程度，采用Spearman秩相关分析ISR患者钙化程度与再狭窄的相关性，采用单因素及多因素logistic回归分析筛选发生再狭窄的预后因素。结果DCB术后1年总体再狭窄率31.0%(39/126)。再狭窄率与PACSS分级呈正相关(r=0.560，P<0.001)。多因素logistic回归分析表明，病变部位累及腘动脉(OR=2.820，95% CI：1.025~7.758)，PACSS分级3或4级(OR=15.872，95% CI：5.093~49.468)是DCB治疗ISR后再狭窄的独立影响因素(P<0.05)。无钙化组(PACSS 0级，n=47)、轻中度钙化组(PACSS 1、2级，n=43)与重度钙化组(PACSS 3、4级，n=36)比较，重度钙化组年龄最大［3组分别为(67.7±8.9)、(68.7±7.4)、(72.5±8.8)岁，P=0.031］，病变最长(3组中位数分别为70.4、123.6、134.7 mm，P<0.001)，再狭窄率最高［3组分别为10.6%(5/47)、14.0%(6/43)、77.8%(28/36)，P<0.001］。结论ISR血管钙化程度越重，再狭窄风险越高。除钙化程度外，病变部位累及腘动脉也是DCB治疗ISR后发生再狭窄的独立预后因素。
Abstract:
ObjectiveTo investigate the correlation between vascular calcification degree and restenosis after drugcoated balloon (DCB) treatment for instent restenosis (ISR) of lower extremity arteries.MethodsA retrospective cohort study was adopted, ultimately including 126 patients with ISR treated with DCB in this hospital from January 2019 to March 2023. The outcome indicator was restenosis defined by imaging review during 1year followup. The Peripheral Artery Calcification Scoring System (PACSS) was applied to evaluate vascular calcification at the ISR lesion site. Spearman rank correlation analysis was used to assess the correlation between calcification degree and restenosis. Univariate and multivariate logistic regression analyses were performed to screen prognosis factors for restenosis.ResultsThe overall restenosis rate at 1 year postDCB was 31.0% (39/126), and it was positively correlated with PACSS classification (r=0.560, P<0.001). Multivariate logistic regression analysis indicated that lesion involving the popliteal artery (OR=2.820, 95%CI: 1.025-7.758) and PACSS classification of grade 3 or 4 (OR=15.872, 95%CI: 5.093-49.468) were independent influence factors for restenosis after DCB treatment for ISR (P<0.05). Comparing the noncalcification group (PACSS grade 0, n=47), mildtomoderate calcification group (PACSS grades 1-2, n=43), and severe calcification group (PACSS grades 3-4, n=36), the severe calcification group had the oldest age ［the three groups were (67.7±89), (68.7±74), and (72.5±8.8) years old, respectively, P=0.031］, longest lesion length (the median values of the three groups were 704, 123.6, and 134.7 mm, respectively, P<0.001), and highest restenosis rate ［the three groups were 10.6% (5/47), 14.0% (6/43), and 77.8% (28/36), respectively, P<0.001］.ConclusionsThe more severe the ISR vascular calcification, the higher the risk of restenosis. In addition to calcification degree, lesion involving the popliteal artery is also an independent prognostic factor for restenosis after DCB treatment for ISR.

参考文献/References:

[1]Qin Y,Shi Y,Zhuo H,et al.Shortterm efficacy and safety of TurboHawk atherectomy for instent restenosis in peripheral artery disease:a singlecentre experience.ANZ J Surg,2022,92(3):448-452.
[2]Zhen Y,Ren H,Chen J,et al.Systematic review and metaanalysis of drugcoated balloon angioplasty for instent restenosis in femoropopliteal artery disease.J Vasc Interv Radiol,2022,33(4):368-374.
[3]Taha AG,Saleh MI,Ali H,et al.Predictors of recurrence after paclitaxel drugcoated balloon use for treating femoropopliteal instent restenosis.Vascular,2024,32(4):834-841.
[4]Li Q,Wang L,Zhu L,et al.Paclitaxelcoated versus uncoated balloon for femoropopliteal instent restenosis:a systematic review and metaanalysis.Rev Cardiovasc Med,2022,23(9):315-329.
[5]田少勇,杨彦林,吴国良.药物涂层球囊扩张对下肢动脉硬化闭塞症病人术后再狭窄及外周血ET1、HMGB1的影响.中西医结合心脑血管病杂志,2023,21(6):1122-1126.
[6]李敏,朱奕,方丽娟,等.Wnt信号通路在动脉粥样硬化及血管钙化中的研究进展.中国动脉硬化杂志,2021,29(11):995-999.
[7]Yuan C,Ni L,Zhang C,et al.Vascular calcification:new insights into endothelial cells.Microvasc Res,2021,134:104105.
[8]Iida O,Urasawa K,Shibata Y,et al.Clinical safety and efficacy of rotational atherectomy in Japanese patients with peripheral arterial disease presenting femoropopliteal lesions:the JSUPREME and JSUPREME II trials.J Endovasc Ther,2022,29(2):240-247.
[9]《药物涂层球囊临床应用中国专家共识》专家组.药物涂层球囊临床应用中国专家共识.中国介入心脏病学杂志,2016,24(2):61-67.
[10]Zen K,Takahara M,Iida O,et al.Drugeluting stenting for femoropopliteal lesions,followed by cilostazol treatment,reduces stent restenosis in patients with symptomatic peripheral artery disease.J Vasc Surg,2017,65(3):720-725.
[11]中国高血压防治指南修订委员会,中国高血压联盟,中华医学会心血管病学分会中国医师协会高血压专业委员会,等.中国高血压防治指南(2018年修订版).中国心血管杂志,2019,24(1):24-56.
[12]Kidney Disease:Improving Global Outcomes (KDIGO) CKD Work Group.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl,2013,3(1):1-150.
[13]RochaSingh KJ,Zeller T,Jaff MR.Peripheral arterial calcification:prevalence,mechanism,detection,and clinical implications.Catheter Cardiovasc Interv,2014,83(6):E212-E220.
[14]Rutherford RB,Baker JD,Ernst C,et al.Recommended standards for reports dealing with lower extremity ischemia:revised version.J Vasc Surg,1997,26(3):517-538.
[15]Aboyans V,Criqui MH,Abraham P,et al.Measurement and interpretation of the anklebrachial index:a scientific statement from the American Heart Association.Circulation,2012,126(24):2890-2909.
[16]李立强,高喜翔,佟铸,等.紫杉醇药物涂层球囊治疗椎动脉开口支架内再狭窄的疗效分析.中国现代手术学杂志,2025,29(6):451-455.
[17]唐垚,贺迎坤,赵耀,等.药物涂层球囊治疗椎基底动脉支架内再狭窄的应用研究.中华放射学杂志,2022,56(1):87-92.
[18]王承芳,余朝文,任天才,等.股腘动脉支架内再狭窄患者药物涂层球囊血管成形术后1年再狭窄的影响因素分析.中华解剖与临床杂志,2023,28(6):388-394.
[19]王辉,苏志向,谷涌泉.准分子激光斑块消蚀术联合药物涂层球囊治疗股腘动脉支架内再狭窄研究进展.介入放射学杂志,2022,31(5):507-510.
[20]王庆贺,唐晨,王宜梅,等.髂动脉钙化评分与下肢动脉硬化闭塞症患者药物涂层球囊联合支架植入术后下肢动脉再狭窄的相关性及其预测价值分析.中华医学杂志,2024,104(37):3520-3527.
[21]赵起健,张建彬,贺斌,等.国产紫杉醇药物涂层球囊治疗长段闭塞性股腘动脉病变中期疗效的单中心研究.中华血管外科杂志(中英文),2024,9(1):31-36.
[22]Colombo M,Corti A,Berceli S,et al.3D modelling of drugcoated balloons for the treatment of calcified superficial femoral arteries.PloS One,2021,16(10):e0256783.
[23]张永保,滕乐群,房杰,等.紫杉醇药物球囊治疗股腘动脉粥样硬化性病变的疗效分析.中华普通外科杂志,2022,37(3):184-188.
[24]Tzafriri AR,GarciaPolite F,Zani B,et al.Calcified plaque modification alters local drug delivery in the treatment of peripheral atherosclerosis.J Control Release,2017,264:203-210.
[25]Kocelak P,PuzianowskaKuznicka M,OlszaneckaGlinianowicz M,et al.Wnt signaling pathway and sclerostin in the development of atherosclerosis and vascular calcification.Adv Clin Exp Med,2024,33(5):519-532.
[26]Chowdhury MM,Albaghdadi MS,Mauskapf A,et al.Abstract 11227.Multimodality molecular imaging to assess the role of inflammation and microcalcification in the pathobiology of restenosis in peripheral arterial disease:a prospective clinical and translational study.Circulation,2018,138(Sup1):4.
[27]Poredos P,Cevc M,Blinc A.Characteristics of atherosclerosis in femoropopliteal artery and its clinical relevance.Atherosclerosis,2021,335(10):31-40.
[28]Shahbad R,Pipinos M,Jadidi M,et al.Structural and mechanical properties of human superficial femoral and popliteal arteries.Ann Biomed Eng,2024,52(4):794-815.
[29]Cioppa A,Leone A,Pucciarelli A,et al.Combined therapy with rotational atherectomy and drug coated balloon for superficial femoral artery instent restenosis:safety,efficacy,and twoyear results of a single center experience.Minerva Cardiol Angiol,2023,71(5):599-605.

备注/Memo

备注/Memo:
基金项目：河北省卫生健康委医学科学研究课题计划(20242048)**通讯作者，Email：litianrun@163.com①(河北省保定市清苑区人民医院血管外科，保定071100)
更新日期/Last Update: 2026-06-22