用血栓弹力图评价抗血小板药物疗效对颅内外动脉支架术后再狭窄.docVIP

·临床研究· 用血栓弹力图评估抗血小板药物疗效对颅内外动脉支架术后再狭窄影响的研究 李 敏, 刘 玲, 葛 良, 蓝文雅, 侯华娟, 林 颖, 杨 昉, 刘亚红*1 （南京大学附属南京军区南京总医院（金陵医院）神经内科, 南京210002） 【摘 要】目的 运用血栓弹力图仪（TEG）检测颅内外动脉支架置入术（PTAS）后患者服用阿司匹林和氯吡格雷后血小板聚集的抑制率，了解阿司匹林和氯吡格雷的疗效，探讨其疗效对颅内外动脉PTAS术后支架再狭窄（ISR）的影响。方法 共收集颅内外动脉PTAS术后因缺血性中风复发（6例）或者术后6-12个月常规行DSA随访（43例）且行血栓弹力图（TEG）检测的49例患者的临床资料，共有64处病变血管行PTAS治疗。DSA复查证实14处血管病变发生ISR（ISR组），50处病变血管无ISR（对照组）；采用统计软件SPSS15.0比较ISR和无ISR组患者的各种血管病危险因素，血清超敏C反应蛋白（hs-CRP）水平，花生四烯酸（AA）途径诱导的血小板抑制率和腺苷二磷酸（ADP）受体途径诱导血小板抑制率间的差异，并分析影响ISR形成的因素。结果 （1）缺血性卒中复发与常规复查比较：复发组为6例（男性：n＝＝＝＝＞＝＝＝＝＝＝Efficacy of antiplatelet aggregation drugs in in-stent restenosis after intra- or extra-cerebral stent placement: evaluation by thrombelastogramy LI Min, LIU Ling, GE Liang, LAN Wenya, HOU Huajuan, LIN Ying, YANG Fang, LIU Yahong (Department of Neurology, Nanjing General (Jinling) Hospital of Nanjing Military Command, Nanjing University, Nanjing 210002, China) 【Abstract】 Objective To evaluate the efficacy of antiplatelet aggregation drugs (aspirin and clopridogrel) in in-stent restenosis (ISR) after percutaneous transluminal angioplasty and stenting (PTAS) by using thromboelastography (TEG) to assess the inhibitory rates of platelet aggregation. Methods Clinical data of 49 patients who were rehospitalizated in 6 to 12 months after PTAS for conventional re-evaluation by digital subtraction angiography (DSA) and TEG, and 6 patients with recurrent ischemic stroke (infarction or transient) after intra- or extra-cerebral stent placement in our hospital in November 2010 to May 2012 were collected. All patients were assessed the inhibitory rates of arachidonic acid (AA) pathway and adenosine diphosphate （ADP） receptor pathway in platelets by TEG. DSA confirmed 14 ISR among 64 lesion vessels treated with stents (ISR group). Potential variables for restenosis and the inhibitory rates of AA pathway and ADP receptor pathway in platelets were analyzed for any predictive power for the ISR with SPSS version 15.0. Results (1) There was significant