Napovedni dejavniki za ponovne zožitve stegenske arterije po perkutani transluminalni angioplastiki

Boc, Vinko (author), Blinc, Aleš (mentor), Božič Mijovski, Mojca (comentor)

Izhodišče: Perkutana transluminalna angioplastika (PTA) predstavlja prednosten način revaskularizacijskega zdravljenja periferne arterijske bolezni (PAB). Kljub napredku tehnologije pa je v področju stegenske arterije pojavnost ponovnih zožitev še vedno visoka. Namen: Proučiti smo želeli, kako na verjetnost ponovne zožitve stegenske arterije po PTA vplivajo arterijski iztok v golen, hemostatski potencial in nekateri genetski dejavniki. Preiskovanci in metode dela: V raziskavo smo vključili 206 zaporednih preiskovancev s PAB v fazi omejujoče intermitentne klavdikacije, pri katerih smo opravili PTA stegenske arterije. Preiskovance smo spremljali eno leto in z ultrazvočno preiskavo arterij mesec dni, pol leta in leto dni po posegu ocenili prehodnost zdravljene arterije. Uro pred posegom in 24 ur po posegu smo preiskovancem odvzeli kri za določitev laboratorijskih kazalnikov hemostaze in vnetja ter za analizo polimorfizmov v genih NR4A2 in PECAM1. Rezultati: Ponovna zožitev stegenske arterije je prizadela 45 % preiskovancev. Slab iztok v golen je povečal tveganje za ponovno zožitev po prvem mesecu (p = 0,005) in po šestih mesecih (p = 0,003), v naslednjih 6 mesecih pa ne (p = 0,628). Preiskovanci z zdravljeno arterijsko hipertenzijo so ponovno zožitev utrpeli redkeje kot tisti brez hipertenzije (OR 0,21; 95% CI: 0,07-0,67; p = 0,009). V laboratorijskih izvidih smo pri preiskovancih s ponovno zožitvijo ugotovili podaljšano fazo zamika tvorjenja trombina (pred posegom p = 0,042, po posegu p = 0,027) in večji prispevek mikrodelcev na koncentracijo trombina (pred posegom p < 0,001, po posegu p = 0,006). Polimorfizmi posameznega nukleotida genov NR4A2 in PECAM1 na verjetnost ponovne zožitve niso imeli vpliva. Pri polimorfizmu rs1466408 gena NR4A2 smo po posegu ugotovili zmanjšano izražanje gena. V multivariatni analizi sta se kot napovedna dejavnika ponovne zožitve izkazala slab iztok v golen (OR 5,72; 95% CI: 1,73-18,95; p = 0,004) in večja kompleksnost lezije, ocenjena s TASC II klasifikacijo (razred B vs razred A (OR 3,43; 95% CI: 1,51-7,79; p = 0,003) in razred C vs razred A (OR 9,83; 95% CI: 3,34-28,95; p < 0,001)). Zaključki: Slab iztok v golen in večja kompleksnost lezije glede na TASC II klasifikacijo pomembno vplivata na pojavnost ponovne zožitve stegenske arterije po PTA, medtem ko je zdravljena arterijska hipertenzija varovalni dejavnik. Povezave med povečano tvorbo trombina ter CHP in ponovno zožitvijo arterije nismo potrdili. Polimorfizmi posameznega nukleotida v nekodirajočih delih genov NR4A2 in PECAM1 niso vplivali na ponovno zožitev arterije.

• Language: Slovenian
• Keywords: periferna arterijska bolezen, perkutana transluminalna angioplastika, arterijski iztok v golen, tvorjenja trombina, polimorfizmi posameznega nukleotida
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2021
• PID: 20.500.12556/RUL-132769
• COBISS.SI-ID: 90384643
• Publication date in RUL: 02.11.2021

Secondary language

• Language: English
• Title: Prognostic factors for restenosis of femoral artery after the percutaneous transluminal angioplasty

Abstract

Background: Percutaneous transluminal angioplasty (PTA) is the preferred method of revascularization treatment of peripheral arterial disease (PAD). Despite advances in technology, the incidence of restenosis in the femoral artery is still high. Aim: We wanted to study how is the likelihood of the femoral artery restenosis affected by the infrapopliteal arterial run-off, haemostatic potential, and certain genetic factors. Patients and methods: The study included 206 consecutive patients with PAD and limiting intermittent claudication in whom PTA of the femoral artery was performed. Patients were monitored for one year and the patency of the treated artery was assessed by ultrasound examination of the arteries one month, six months and one year after the procedure. One hour before the procedure and 24 hours after the procedure, thrombin generation, overall haemostatic potential (OHP) and single nucleotide polymorphisms (SNPs) in the NR4A2 and PECAM1 genes were assessed. Results: Restenosis of the femoral artery occurred in 45% of patients. Poor infrapopliteal run-off increased the risk of restenosis after one month (p = 0.005) and after six months (p = 0.003), but not during the following 6 months (p = 0.628). Patients with treated arterial hypertension were less likely to experience restenosis than patients without hypertension (OR 0.21; 95% CI: 0.07-0.67; p = 0.009). Patients with restenosis were found to have delayed phase time in thrombin generation (before procedure p = 0.042, after procedure p = 0.027) and a higher contribution of microparticles to thrombin concentration (before procedure p < 0.001, after procedure p = 0.006). SNPs of the NR4A2 and PECAM1 genes had no effect on the likelihood of restenosis. For the rs1466408 polymorphism of the NR4A2 gene, we found reduced gene expression after PTA. In the multivariate analysis, poor infrapopliteal run-off (OR 5.72; 95% CI: 1.73-18.95; p = 0.004) and higher lesion complexity assessed by the TASC II classification (type B vs type A lesions (OR 3.43; 95% CI: 1.51-7.79; p = 0.003) and type C vs type A lesions (OR 9.83; 95% CI: 3.34-28.95; p < 0.001)) proved to predict restenosis. Conclusions: Poor infrapopliteal run-off and greater lesion complexity significantly influence the incidence of restenosis of the femoral artery after PTA, while treated arterial hypertension is a protective factor. The association of restenosis with thrombin generation and OHP was not confirmed. SNPs of the NR4A2 and PECAM1 genes did not affect the probability of arterial restenosis.

• Keywords: peripheral arterial disease, percutaneous transluminal angioplasty, infrapopliteal arterial run-off, thrombin generation, single nucleotide polymorphisms