Analysis Of The Efficacy Of Drug-coated Balloon Combined With Stent In The Treatment Of Left Subclavian Artery Stenosi

Background:The subclavian artery is an important supply vessel for the posterior cerebral circulation system.Subclavian artery stenosis is a common cause of posterior circulation ischemic stroke,and the left side is more prone to stenosis due to its hemodynamics.In recent years,endovascular surgery has gradually replaced open surgery as the first choice.Although the curative effect of plain balloon combined with stent is better than that of single balloon dilatation,most patients still have restenosis after stent implantation,and maintaining lumen patency is still the focus of attention.It is not clear whether the drug-coated balloon has a higher postoperative patency rate.Obiective:The purpose of the study is to verify the safety and effectiveness of drug-coated balloon combined stent in the left subclavian artery stenosis,compare the stent patency rate after drug-coated balloon and plain balloon combined with stent treatment,and summarize the independent risk factors for in-stent restenosis.Methods: Retrospective observation was used to screen the patients who received left subclavian artery stenosis/occlusion treatment in our center from January 2015 to March 2022 according to the inclusion and exclusion criteria.According to whether the drug-coated balloon was used during the operation,the patients were divided into the drug-coated balloon group and the plain balloon group.Statistical analysis of the two groups of patients with general clinical data,preoperative vascular stenosis,the type of balloon used during the operation and stent type,size,intraoperative vascular residual stenosis rate and perioperative complications.The incidence of in-stent restenosis and related complications during follow-up were collected according to postoperative review.The data were statistically analyzed by IBM SPSS 27.0,and the data conforming to the normal distribution were expressed by (?)±S,and the comparison between groups was made by t-test.The data of non-normal distribution is represented by [M(P25,P75)] and Mann-Whitney U test is used for analysis.Enumeration data were expressed as(rate),and inter-group comparison was performed using Chi-square test or Fisher’s exact probability method.The Kaplan-Meier curve was used to analyze stent patency rate,and Graph Pad Prism 9 software was used for drawing.Independent risk factors of stent restenosis were analyzed by univariate and multivariate Cox regression.p<0.05 was statistically significant.Results: A total of 84 patients who received balloon dilatation and stent placement with complete follow-up records were included in this study.The median follow-up time was 28months(IQR16-52 months).The incidence of in-stent restenosis was 13.1%(11/84 cases).There was a statistical difference in stent patency rates between drug-coated balloon group and plain balloon groups(96.9% vs 80.4%;p=0.023).Multivariate Cox regression analysis indicated that lesion length ≥ 20 mm(HR=8.210;95%CI:1.893-35.611;p=0.005),balloon type(HR=11.161;95%CI:1.203-103.537;p=0.034)and residual stenosis rate(HR=1.103;95%CI:1.022-1.191;p=0.012)were the independent risk factors for in-stent restenosis in our patient.Conclusion:(1)Drug-coated balloon combined with stent therapy has good surgical safety and effectiveness.(2)Compared with plain balloon,drug-coated balloon can better alleviate lumen loss in the stent,and have better patency after surgery.(3)The risk factors for in-stent restenosis were lesion length ≥20mm,balloon type and residual stenosis rate.Attention should be paid to the intraoperative management and postoperative management of the aforementioned risk factors.