Cheung Y F, Sanatani S, Leung M P, Human D G, Chau A K, Culham J A
Grantham Hospital, Department of Pediatrics, University of Hong Kong, Aberdeen.
J Am Coll Cardiol. 2000 Mar 15;35(4):1007-15. doi: 10.1016/s0735-1097(99)00644-0.
We report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease.
The inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent.
Twenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8+/-4.5 years and 30.5+/-14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented.
All the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1+/-1.5 to 8+/-2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6+/-15.8 to 12.1+/-11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3+/-0.5 to 7.5+/-0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0+/-2.9 to 0.9+/-1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (<9 mm) and longer period after implantation.
Self-expanding Wallstent could be deployed easily and safely to relieve vascular stenoses in children. The complications of distal migration, significant neointimal ingrowth and its unyielding design to overdilation limit its application to this patient group.
我们报告了自膨式Wallstent支架（瑞士施奈德公司）植入先天性心脏病患儿后的早期和中期随访结果。
球囊扩张式支架的固有缺点促使人们尝试使用另一种支架。
1993年12月至1997年6月期间，在两家机构中，20例患者接受了25枚自膨式Wallstent支架的22次植入手术。平均年龄和体重分别为10.8±4.5岁和30.5±14.2千克。患者分为两组：1）第一组包括17例肺动脉狭窄患者，2）第二组包括4例静脉狭窄患者（其中1例同时属于两组）。16例患者在支架植入后中位时间5.8个月（范围0.5至31个月，平均8.1个月）接受了再次心导管检查。记录了介入操作后的血流动力学和血管造影变化以及并发症情况。
所有支架均成功放置在预定位置。在第一组中，置入支架血管的最窄直径从4.1±1.5毫米增加到8±2毫米（增加95%，p<0.0001），而跨支架的收缩压梯度从24.6±15.8毫米汞柱降至12.1±11.4毫米汞柱（降低51%，p = 0.001）。在第二组中，最窄节段的尺寸变化从4.3±0.5毫米增加到7.5±0.4毫米（增加75%，p = 0.003），跨支架静脉通道的压力梯度从5.0±2.9毫米汞柱降至0.9±1.0毫米汞柱（降低82%，p = 0.04）。两枚位置最佳的支架在植入后24小时内发生了远端移位。在再次心导管检查时，25枚植入支架中有7枚（28%）出现了明显的新生内膜增生（>扩张直径的30%）。这种情况对球囊扩张反应不佳。新生内膜增生的易感因素包括直径较小（<9毫米）的支架和植入后较长时间。
自膨式Wallstent支架可轻松、安全地用于缓解儿童血管狭窄。远端移位、明显的新生内膜增生及其对过度扩张的不适应性等并发症限制了其在该患者群体中的应用。
