Breinholt John P, Nugent Alan W, Law Mark A, Justino Henri, Mullins Charles E, Ing Frank F
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Catheter Cardiovasc Interv. 2008 Dec 1;72(7):977-82. doi: 10.1002/ccd.21742.
To describe incidence, characteristics, predictive factors, and sequelae of stent fractures in congenital heart disease.
Stent fracture in congenital heart disease patients is rarely reported.
Patients with stents implanted from 1990 to 2006, with subsequent fluoroscopy were enrolled. Information obtained included: stent type, location, balloon diameter, and residual narrowing. Fracture characteristics, radiographic appearance, and clinical sequelae were also obtained in those with fractures identified.
: Two hundred and sixty-five patients (583 stents) had fluoroscopy 4.2 +/- 3.3 years after stent implantation. The majority of stents (395, 67.7%) were placed in a pulmonary artery (PA) or its branches. Sixteen stents (2.7%) were placed in a right ventricle to pulmonary artery (RV-PA) conduit. Fourteen fractures (2.4%) were identified 5.0 +/- 3.2 years after implantation: RV-PA conduit 4/16, proximal right PA 4/135, proximal left PA 6/184 (P = 0.003). Identification was primarily made on lateral fluoroscopy. Review of chest radiographs demonstrated fractures in only 71%. In fractured PA stents, five were redilated and three had additional stents placed. Of the four conduit stent fractures: one underwent redilation, one had embolized segments, and one was reinforced with a second stent that also fractured and embolized a segment during redilation at a later catheterization. All fractures were asymptomatic.
With the exception of RV-PA conduit stents, fracture is rare and asymptomatic. PA stent fractures occurred in 2.5% and did not embolize, whereas RV-PA conduit stent fractures were significantly more common and may embolize.
描述先天性心脏病支架骨折的发生率、特征、预测因素及后遗症。
先天性心脏病患者的支架骨折鲜有报道。
纳入1990年至2006年间植入支架并随后接受荧光透视检查的患者。获取的信息包括：支架类型、位置、球囊直径和残余狭窄。对已确认骨折的患者还获取了骨折特征、影像学表现及临床后遗症。
265例患者（583个支架）在支架植入后4.2±3.3年接受了荧光透视检查。大多数支架（395个，67.7%）置于肺动脉（PA）或其分支。16个支架（2.7%）置于右心室至肺动脉（RV-PA）管道。植入后5.0±3.2年发现14例骨折（2.4%）：RV-PA管道4/16，右肺动脉近端4/135，左肺动脉近端6/184（P = 0.003）。主要通过侧位荧光透视检查发现。胸部X线片复查仅在71%的病例中显示骨折。在骨折的PA支架中，5个进行了再次扩张，3个额外置入了支架。在4例管道支架骨折中：1例进行了再次扩张，1例有栓塞节段，1例用第二个支架加固，但在后来的导管插入术中再次扩张时该支架也发生骨折并栓塞了一个节段。所有骨折均无症状。
除RV-PA管道支架外，骨折罕见且无症状。PA支架骨折发生率为2.5%且未发生栓塞，而RV-PA管道支架骨折明显更常见且可能发生栓塞。
