EFFECT OF LIPID MODIFICATION ON PERIPHERAL ARTERIAL DISEASE AFTER ENDOVASCULA

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 研究假设如下：强化调脂联合治疗将通过减少血栓形成和炎症，抑制动脉粥样硬化的进展，减少血管内支架置入术后股动脉再狭窄的发生率。 一般情况下，我们将招募120名有症状的单腿股动脉闭塞症患者。这些患者将接受血管内支架治疗，然后被随机分成两组：1)标准的医疗护理，包括他汀类药物治疗；2)标准的医疗护理标准，使用他汀类药物加依折麦布和缓释烟酸进行强化的血脂调节，以提高高密度脂蛋白(&gt；40)，降低低密度脂蛋白(&lt；80)和甘油三酯(&lt；150)。具体地说，我们将对这些患者进行为期2年的跟踪调查，并研究以下具体目标： 1.应用高分辨率磁共振成像技术检测支架内再狭窄的股动脉和对侧股动脉的动脉粥样硬化进展情况，以确定强化调脂治疗对股动脉粥样硬化和再狭窄的影响。 2.通过双功超声、节段性肢体压力、节段性脉搏容量记录、踝臂指数、跑步机步行距离、绝对跛行等检查，确定强化调脂治疗对PTA血管重建术和支架植入术患者的临床血流动力学指标、临床症状、系统性主要心血管事件的减少和总体生活质量的影响。 生活质量问卷。 3.确定强化调脂治疗对脂蛋白、炎症的影响，以及与PAD进展、再狭窄和临床事件的关系。 4.探讨强化调脂治疗对血栓形成的影响及其与PAD进展、再狭窄和临床事件的关系。这些血液测试与临床结果和股动脉成像的相关性将被确定。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The hypothesis for the study is as follows: Intensive lipid modification with combination therapy will inhibit the progression of atherosclerosis and reduce the incidence of restenosis in femoral arteries following endovascular stenting by decreasing thrombosis and inflammation. In general, we will recruit a total of 120 patients with symptomatic femoral artery occlusive disease in one leg. These patients will be treated with endovascular stenting, and then randomized into two treatment groups: 1)standard of medical care including statin therapy; and 2) standard of medical care with intensive lipid modification using a statin plus ezetimibe and extended release niacin to increase HDL (>40) and decrease LDL (<80) and TG (<150). Specifically, we will follow these patients for 2 years and study the following specific aims: 1. To determine the effect of intensive lipid modification therapy on progression of atherosclerosis and restenosis of femoral arteries using high resolution MRI image technology to exam both the stented femoral artery for in-stent restenosis and the contralateral fermoral artery for progression of atherosclerosis. 2. To determine the effect of intensive lipid modification therapy on the clinically applicable hemodynamic measurements, clinical symptoms, reduction in systemic major cardiovascular events and the general quality of life of patients following PTA revascularization and stenting by assessment with Duplex ultrasound, segmental limb pressure, segmental pulse volume recording, ankle brachial indicies, treadmill walking distance, absolute claudication and quality of life questionnaires. 3. To determine the effect of intensive lipid modification therapy on lipoproteins, inflammation, and relationship to PAD progression, restenosis, and clinical events. 4. To determine the effect of intensive lipid modification therapy on thrombosis, and relationship to PAD progression, restenosis and clinical events. The association of these blood tests with clinical outcome and femoral artery image will be determined.