McMahon C J, El-Said H G, Grifka R G, Fraley J K, Nihill M R, Mullins C E
LillieFrank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston 77030, USA.
J Am Coll Cardiol. 2001 Aug;38(2):521-6. doi: 10.1016/s0735-1097(01)01406-1.
We sought to determine the incidence of and risk factors for the development of restenosis and neointimal proliferation after endovascular stent implantation for congenital heart disease (CHD).
Risk factors for the development of restenosis and neointimal proliferation are poorly understood.
This was a retrospective review of patients who underwent endovascular stent redilation between September 1989 and February 2000.
Of 368 patients who had 752 stents implanted, 220 were recatheterized. Of those 220 patients, 103 underwent stent redilation. Patients were classified into three groups: 1) those with pulmonary artery stenosis (n = 94), tetralogy of Fallot/pulmonary atresia (n = 72), congenital branch pulmonary stenosis (n = 9), status post-Fontan operation (n = 6), status post-arterial switch operation (n = 7); 2) those with iliofemoral venous obstruction (n = 6); and 3) those with miscellaneous disorders (n = 3). The patients' median age was 9.9 years (range 0.5 to 39.8); their mean follow-up duration was 3.8 years (range 0.1 to 10). Indications for stent redilation included somatic growth (n = 67), serial dilation (n = 27) and development of neointimal proliferation or restenosis, or both (n = 9). There was a low incidence of neointimal proliferation (1.8%) and restenosis (2%). There were no deaths. Complications included pulmonary edema (n = 1), hemoptysis (n = 1) and contralateral stent compression (n = 2).
Redilation or further dilation of endovascular stents for CHD is effective as late as 10 years. The risk of neointimal proliferation (1.8%) and restenosis (2%) is low and possibly avoidable. Awareness of specific risk factors and modification of the stent implantation technique, including avoidance of minimal stent overlap and sharp angulation of the stent to the vessel wall and avoidance of overdilation, have helped to reduce the incidence of restenosis.
我们试图确定先天性心脏病（CHD）血管内支架植入术后再狭窄和新生内膜增生的发生率及危险因素。
对再狭窄和新生内膜增生发生的危险因素了解甚少。
这是一项对1989年9月至2000年2月期间接受血管内支架再扩张的患者的回顾性研究。
在植入752个支架的368例患者中，220例接受了再次导管检查。在这220例患者中，103例进行了支架再扩张。患者分为三组：1）肺动脉狭窄患者（n = 94）、法洛四联症/肺动脉闭锁患者（n = 72）、先天性分支肺动脉狭窄患者（n = 9）、Fontan手术后患者（n = 6）、动脉调转手术后患者（n = 7）；2）髂股静脉阻塞患者（n = 6）；3）其他杂症患者（n = 3）。患者的中位年龄为9.9岁（范围0.5至39.8岁）；平均随访时间为3.8年（范围0.1至10年）。支架再扩张的指征包括身体生长（n = 67）、系列扩张（n = 27）以及新生内膜增生或再狭窄或两者都出现（n = 9）。新生内膜增生的发生率较低（1.8%），再狭窄发生率为（2%）。无死亡病例。并发症包括肺水肿（n = 1）、咯血（n = 1）和对侧支架受压（n = 2）。
CHD血管内支架的再扩张或进一步扩张在长达10年时都是有效的。新生内膜增生（1.8%）和再狭窄（2%）的风险较低且可能是可避免的。了解特定危险因素并改进支架植入技术，包括避免支架最小重叠、支架与血管壁的锐角以及避免过度扩张，有助于降低再狭窄的发生率。
