Forbes Thomas J, Garekar Swati, Amin Zahid, Zahn Evan M, Nykanen David, Moore Phillip, Qureshi Shakeel A, Cheatham John P, Ebeid Makram R, Hijazi Ziyad M, Sandhu Satinder, Hagler Donald J, Sievert Horst, Fagan Thomas E, Ringewald Jeremy, Du Wei, Tang Liwen, Wax David F, Rhodes John, Johnston Troy A, Jones Thomas K, Turner Daniel R, Pedra Carlos A C, Hellenbrand William E
Division of Cardiology, Children's Hospital of Michigan, and Wayne State University, Detroit, Michigan 48201, USA.
Catheter Cardiovasc Interv. 2007 Aug 1;70(2):276-85. doi: 10.1002/ccd.21164.
We report a multi-institutional experience with intravascular stenting (IS) for treatment of coarctation of the aorta.
Data was collected retrospectively by review of medical records from 17 institutions. The data was broken down to prior to 2002 and after 2002 for further analysis. A total of 565 procedures were performed with a median age of 15 years (mean=18.1 years). Successful reduction in the post stent gradient (<20 mm Hg) or increase in post stent coarctation to descending aorta (DAo) ratio of >0.8 was achieved in 97.9% of procedures. There was significant improvement (P<0.01) in pre versus post stent coarctation dimensions (7.4 mm+/-3.0 mm vs. 14.3+/-3.2 mm), systolic gradient (31.6 mm Hg+/-16.0 mm Hg vs. 2.7 mm Hg+/-4.2 mm Hg) and ratio of the coarctation segment to the DAo (0.43+/-0.17 vs. 0.85+/-0.15). Acute complications were encountered in 81/565 (14.3%) procedures. There were two procedure related deaths. Aortic wall complications included: aneurysm formation (n=6), intimal tears (n=8), and dissections (n=9). The risk of aortic dissection increased significantly in patients over the age of 40 years. Technical complications included stent migration (n=28), and balloon rupture (n=13). Peripheral vascular complications included cerebral vascular accidents (CVA) (n=4), peripheral emboli (n=1), and significant access arterial injury (n=13). Older age was significantly associated with occurrence of CVAs. A significant decrease in the technical complication rate from 16.3% to 6.1% (P<0.001) was observed in procedures performed after January 2002.
Stent placement for coarctation of aorta is an effective treatment option, though it remains a technically challenging procedure. Technical and aortic complications have decreased over the past 3 years due to, in part, improvement in balloon and stent design. Improvement in our ability to assess aortic wall compliance is essential prior to placement of ISs in older patients with coarctation of the aorta.
我们报告了一项多机构使用血管内支架置入术（IS）治疗主动脉缩窄的经验。
通过回顾17家机构的病历进行回顾性数据收集。数据按2002年之前和2002年之后进行分类以作进一步分析。共进行了565例手术，中位年龄为15岁（平均=18.1岁）。97.9%的手术成功使支架置入后压差降低（<20 mmHg）或支架置入后缩窄段与降主动脉（DAo）的比率增加至>0.8。支架置入前后缩窄段尺寸（7.4 mm±3.0 mm对14.3±3.2 mm）、收缩压差（31.6 mmHg±16.0 mmHg对2.7 mmHg±4.2 mmHg）以及缩窄段与DAo的比率（0.43±0.17对0.85±0.15）均有显著改善（P<0.01）。81/565（14.3%）例手术出现急性并发症。有2例与手术相关的死亡。主动脉壁并发症包括：动脉瘤形成（n=6）、内膜撕裂（n=8）和夹层（n=9）。40岁以上患者主动脉夹层风险显著增加。技术并发症包括支架移位（n=28）和球囊破裂（n=13）。外周血管并发症包括脑血管意外（CVA）（n=4）、外周栓塞（n=1）和严重的入路动脉损伤（n=13）。年龄较大与CVA的发生显著相关。在2002年1月之后进行的手术中，技术并发症发生率从16.3%显著降至6.1%（P<0.001）。
主动脉缩窄的支架置入是一种有效的治疗选择，尽管它仍然是一项技术上具有挑战性的手术。技术和主动脉并发症在过去3年中有所减少，部分原因是球囊和支架设计的改进。在对年龄较大的主动脉缩窄患者进行IS置入之前，提高我们评估主动脉壁顺应性的能力至关重要。
