Qureshi Athar M, McElhinney Doff B, Lock James E, Landzberg Michael J, Lang Peter, Marshall Audrey C
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Cardiol Young. 2007 Jun;17(3):307-18. doi: 10.1017/S1047951107000339. Epub 2007 Feb 26.
Stenting for aortic coarctation has been shown to be effective in the short term. The safety and longer term efficacy of transcatheter therapy, however, must be well established if the technique is to be widely accepted as an alternative to surgery. In order to determine the frequency, spectrum, and outcome of injury to the aortic wall caused by angioplasty or stenting of aortic coarctation, the nomenclature of mural injury in these patients must be adapted to the conditions of transcatheter therapy.
Between 1989 and July 2005, we inserted stents in 153 patients with aortic coarctation, their median age being 15.8 years. Prior aortic interventions had been performed in 98 patients, and preexisting aneurysms were observed in 19. Stenting resulted in a significant reduction of the gradient across the site of coarctation, from a median of 30 millimetres of mercury to zero (p less than 0.001), with a residual gradient within the aortic arch of 20 millimetres of mercury or more in 5% of patients. Acute injuries to the aortic wall, other than therapeutic tears, were observed in 3 patients (2%), none of whom required surgery. At median follow-up of 2.5 years, this being more than 5 years in 30 patients, 4 patients had died, albeit none from complications relating to stenting or catheterization. Acute injuries to the aortic wall did not progress, and new aneurysms were observed in 6% of patients subsequent to follow-up imaging. Stent fractures, and jailed or partially covered brachiocephalic vessels, were observed in 12, and 49, patients, respectively, but did not result in haemodynamic or embolic complications.
Stenting for aortic coarctation results in consistent relief of the gradient, and few serious complications in the short and intermediate term. Serious injuries to the aortic wall are uncommon in our experience, and can be minimized with a focus on technical measures, such as pre-dilation before stenting.
主动脉缩窄支架置入术已被证明在短期内有效。然而，如果要使经导管治疗技术被广泛接受作为手术的替代方法，其安全性和长期疗效必须得到充分确立。为了确定主动脉缩窄血管成形术或支架置入术导致的主动脉壁损伤的频率、范围和结果，这些患者的壁损伤命名必须适应经导管治疗的情况。
1989年至2005年7月期间，我们为153例主动脉缩窄患者置入了支架，他们的中位年龄为15.8岁。98例患者曾接受过主动脉干预，19例观察到存在动脉瘤。支架置入导致缩窄部位的压力阶差显著降低，从中位30毫米汞柱降至零（p<0.001），5%的患者主动脉弓内残余压力阶差为20毫米汞柱或更高。3例患者（2%）观察到除治疗性撕裂外的主动脉壁急性损伤，均无需手术。中位随访2.5年（30例患者随访超过5年），4例患者死亡，尽管均非死于与支架置入或导管插入术相关的并发症。主动脉壁急性损伤未进展，随访成像后6%的患者观察到新的动脉瘤。分别在12例和49例患者中观察到支架断裂以及头臂血管受压或部分覆盖，但未导致血流动力学或栓塞并发症。
主动脉缩窄支架置入术可使压力阶差持续缓解，短期和中期严重并发症较少。根据我们的经验，主动脉壁严重损伤并不常见，通过关注技术措施，如支架置入前预扩张，可将其降至最低。
