Tyagi S, Kaul U A, Arora R
Department of Cardiology, G. B. Pant Hospital and Maulana Azad Medical College, New Delhi 110002, India.
Cardiovasc Intervent Radiol. 1999 Nov-Dec;22(6):452-6. doi: 10.1007/s002709900431.
The efficacy and safety of endovascular stent implantation to correct dissection or a suboptimal result after percutaneous transluminal angioplasty (PTA) was evaluated in patients suffering from aortic stenosis due to aortoarteritis.
Twelve children and young adults [aged (mean +/- SD) 18.2 +/- 8.7 years] underwent stent implantation after PTA of the aorta, seven for obstructive dissection, four for ineffective balloon dilatation, and one for recurrent restenosis. Nine patients underwent implantation of self-expandable stents and three received balloon-expandable Palmaz stents.
Stent implantation could be successfully performed in all 12 patients. After stent implantation, the peak systolic pressure gradient decreased from 91 +/- 33.5 mmHg to 12.4 +/- 12.5 mmHg (p < 0.001). The diameter of the stenosed segment increased from 4.6 +/- 0.8 mm to 11.1 +/- 1.9 mm (p < 0.001). The dissection was completely covered in all seven patients with dissection. Except for epigastric pain with vomiting in one patient, there was no complication. On follow-up, over 12-57 months (mean 26.8 +/- 10.8 months), 11 patients (91.6%) had marked improvement in their blood pressure. Patients with congestive heart failure and claudication also showed improvement. Repeat catheterization in five patients, between 6-30 months (mean 16.8 +/- 9.1 months) after stent implantation, showed sustained improvement in four and a fusiform, long segment, intrastent restenosis after 30 months in one child. The stenosis was safely redilated.
Endovascular aortic stent implantation is safe and provides good immediate relief in patients with unsatisfactory results after balloon angioplasty. Improvement is sustained in most patients on intermediate-term follow-up.
评估血管内支架植入术在治疗大动脉炎所致主动脉狭窄患者经皮腔内血管成形术（PTA）后夹层形成或效果欠佳情况时的疗效及安全性。
12名儿童及青年患者[年龄（均值±标准差）为18.2±8.7岁]在主动脉PTA后接受了支架植入术，其中7例因阻塞性夹层，4例因球囊扩张无效，1例因复发性再狭窄。9例患者植入了自膨式支架，3例接受了球囊扩张式帕尔马兹支架。
所有12例患者均成功完成支架植入。支架植入后，收缩压峰值梯度从91±33.5 mmHg降至12.4±12.5 mmHg（p<0.001）。狭窄段直径从4.6±0.8 mm增加至11.1±1.9 mm（p<0.001）。7例夹层患者的夹层均被完全覆盖。除1例患者出现上腹部疼痛伴呕吐外，无其他并发症。随访12 - 57个月（平均26.8±10.8个月），11例患者（91.6%）血压显著改善。充血性心力衰竭和间歇性跛行患者也有改善。5例患者在支架植入后6 - 30个月（平均16.8±9.1个月）接受了重复导管检查，4例患者持续改善，1例儿童在30个月后出现梭形、长节段的支架内再狭窄。狭窄部位成功进行了再次扩张。
血管内主动脉支架植入术安全，能使球囊血管成形术效果不佳的患者即刻得到良好缓解。大多数患者在中期随访中病情持续改善。
