Neumann Thomas, Kuniss Malte, Conradi Guido, Sperzel Johannes, Berkowitsch Alexander, Zaltsberg Sergey, Wojcik Maciej, Erkapic Damir, Dill Thorsten, Hamm Christian W, Pitschner Heinz-F
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.
J Cardiovasc Electrophysiol. 2009 Mar;20(3):251-7. doi: 10.1111/j.1540-8167.2008.01316.x.
Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well-recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44-70%. Whether there is additional long-term benefit from PVS stenting is uncertain. The aim of this study was the evaluation of the long-term success after PV stenting of severe stenosis.
Ten patients (pts) with 13 PVS were prospectively evaluated. PV stenting was performed with Palmaz Genesis stents. Magnetic resonance imaging (MRI), lung perfusion scans, and CT-scans were performed before, directly after, and every 12 months thereafter. Primary endpoint of the study was the occurrence of restenosis after PV stenting. After a median follow-up of 47.7 (IQRs 25/75 47.2-48.5) months, the primary endpoint was achieved in 3 out of 13 PVs (23% of the treated PVs). We observed two in-stent restenosis 2 and 4 years after PV stenting. These pts experienced onset of dyspnea some weeks before. After an additional balloon angioplasty, the in-stent restenosis was resolved. In one asymptomatic patient, we observed an occlusion of the PV stent 13 months poststenting. Normalization of lung perfusion was noted 4 years after PV stenting versus directly poststenting in all pts without in-stent restenosis (n = 7).
PVS stenting with stent sizes >or=10 mm seems to be an adequate therapy modality for treatment of severe acquired PVS. Late in-stent restenosis after PVS stenting can occur. The normalization of the initially disturbed lung perfusion scan is possible and remains stable, even 4 years after PVS stenting.
房颤导管消融术后严重肺静脉狭窄（PVS）是一种公认的并发症，进一步报道的发生率为1.3%。有症状的PVS的首选治疗方法是肺静脉（PV）血管成形术，但这种治疗方式后再狭窄率为44%-70%。PVS支架置入术是否有额外的长期益处尚不确定。本研究的目的是评估严重狭窄的PV支架置入术后的长期成功率。
前瞻性评估了10例患者的13处PVS。使用Palmaz Genesis支架进行PV支架置入术。在术前、术后即刻以及此后每12个月进行磁共振成像（MRI）、肺灌注扫描和CT扫描。研究的主要终点是PV支架置入术后再狭窄的发生。中位随访47.7（四分位间距25/75为47.2-48.5）个月后，13处PV中有3处（占治疗PV的23%）达到主要终点。我们在PV支架置入术后2年和4年观察到2例支架内再狭窄。这些患者在几周前出现呼吸困难。再次进行球囊血管成形术后，支架内再狭窄得到缓解。在1例无症状患者中，我们在支架置入术后13个月观察到PV支架闭塞。在所有无支架内再狭窄的患者（n = 7）中，PV支架置入术后4年与术后即刻相比，肺灌注恢复正常。
使用尺寸≥10 mm的支架进行PVS支架置入术似乎是治疗严重获得性PVS的一种合适治疗方式。PVS支架置入术后可能会发生晚期支架内再狭窄。最初受干扰的肺灌注扫描有可能恢复正常，并且即使在PVS支架置入术后4年仍保持稳定。
