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目的观察血管内介入[经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)和支架置入术(stenting)]治疗多发性大动脉炎(Takayasu arteritis,TA)的疗效。方法采用血管内介入(单独PTA或PTA加支架)治疗2002年1月至2009年5月西南医院心血管内科诊断为TA的48例住院患者,其中男性17例,女性31例,年龄19～53(27.6±18.1)岁。分析其治疗结果及平均42.8个月的红细胞沉降率、C反应蛋白、CTA、MRA、多普勒血管超声等随访资料。结果通过血管造影在48例TA患者中发现180处病变,并对其中101处严重的病变进行血管内介入治疗。在101处进行血管内介入治疗的病变中,锁骨下动脉/无名动脉29处,颈动脉28处,肾动脉34处,肺动脉2处,冠状动脉8处。101处病变均取得了良好靶病变血运重建术效果,76处(75.2%)没有残余狭窄,25处(24.8%)仅有很少残余狭窄。随访期内(3个月至6年)有3处(12.0%,3/25)仅行PTA治疗的病变发生了再狭窄,有5处(6.5%,5/76)采用PTA+支架治疗的病变发生了再狭窄,所有再狭窄的病变均再次成功行血管内介入治疗,没有出现明显并发症。结论单纯PTA或PTA加支架置入术等血管内介入是治疗慢性非活动性TA的一种安全、有效的方法。
Objective To observe the effect of endovascular interventional therapy [percutaneous transluminal angioplasty (PTA) and stenting] for the treatment of Takayasu arteritis (TA). Methods A total of 48 inpatients with TA diagnosed at Department of Cardiology of Southwest Hospital from January 2002 to May 2009 were treated with endovascular intervention (PTA or PTA alone). There were 17 males and 31 females, aged 19-53 (27.6 ± 18.1) years old. Analysis of the treatment results and average follow-up of 42.8 months of erythrocyte sedimentation rate, C-reactive protein, CTA, MRA, Doppler ultrasound. Results 180 lesions were detected in 48 patients with TA by angiography and 101 of them were treated with endovascular intervention. Of the 101 lesions subjected to endovascular intervention, there were 29 subclavian / unnamed arteries, 28 carotid arteries, 34 renal arteries, 2 pulmonary arteries and 8 coronary arteries. There was no residual stenosis in 76 lesions (75.2%), and only a few residual stenosis in 25 lesions (24.8%). During the follow-up period (3 months to 6 years), 3 cases (12.0%, 3/25) had restenosis only with PTA. There were 5 lesions (6.5%, 5/76) treated with PTA + stent Restenosis occurred, all the restenosis lesions were again successfully endovascular interventional treatment, no significant complications. Conclusions Endovascular intervention such as simple PTA or PTA plus stenting is a safe and effective method for the treatment of chronic non-active TA.