腎動脈ステントの際に栓塞性保護と血小板阻害
Christopher J Cooper1, Steven T Haller, William Colyer
1Cardiovascular Division, University of Toledo, 3000 Arlington Ave, MS 1036, Toledo, OH 43614, USA. Christopher.cooper@utoledo.edu
Circulation
|May 21, 2008
まとめ
腎動脈ステントは腎臓の機能を損なう可能性があります. 栓塞性保護装置とアブキシマブ (グリコプロテインIIb/IIIa阻害剤) の併用療法により,単独の治療法とは異なり,腎臓機能が保たれた.
科学分野:
- 心血管の介入 心血管の介入
- ネフロロジーはネフロロジーを用います.
- 介入性心臓病学 介入性心臓病学
背景:
- 腎臓動脈ステントを設置する際には,腎臓機能の保全が不可欠です.
- アテロエンボリゼーションは,手術後の腎機能不全の既知の原因です.
- 腎臓機能の保全における栓塞性保護装置とグリコプロテインIIb/IIIa阻害剤の有効性は不明である.
研究 の 目的:
- 腎動脈ステントの際に,栓塞性保護装置とグリコプロテインIIb/IIIa阻害剤の併用使用を評価する.
- これらの介入が処置後の腎機能の改善または保存を決定する.
主な方法:
- 2x2の因数式設計で,腎動脈ステントを施す100人の患者をランダムに選んだ.
- 介入には,栓塞性保護装置 (Angioguard) とグリコプロテインIIb/IIIa阻害剤 (アブキシマブ) が含まれていた.
- グロメルーラフィルタレーション率 (GFR) の変化は,腎臓疾患における食事の変化 (MDRD) の1ヶ月の方程式を用いて評価されました.
主要な成果:
- 腎動脈ステントは単独で,栓塞性保護で,またはアブシキシマブ単独でGFRの低下をもたらしました.
- Angioguardとabciximabの両方の組み合わせ治療は,GFRの低下を予防し,他のグループよりも優れていた.
- アブキシマブは,フィルター内の血小板に富んだ血栓を (42%から7%まで) 大幅に減少させた.
結論:
- 腎動脈ステントは,栓塞性保護と無関係,またはアブシキシマブ単独で,腎機能の低下と関連していました.
- 相互作用が観察され,併用療法では優れた腎機能の保存が示されました.
- Angioguardとabciximabの組み合わせは,腎動脈ステント手術中に腎機能の保全に潜在的な利点を提供しています.
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