Department of Pediatric Cardiology, Stroke & Cardiovascular Center, Ehime University Hospital, Ehime, Japan.
J Cardiol. 2010 Nov;56(3):287-90. doi: 10.1016/j.jjcc.2010.06.005. Epub 2010 Aug 21.
In western countries, the use of a balloon-expandable covered stent is recommended for the treatment of native coarctation of the aorta (CoA) in adult patients because endovascular bare stents cannot completely prevent complications such as aneurysms or aortic rupture. However, such a product that is appropriate and officially approved is not available in Japan. We developed and used a handmade balloon-expandable covered stent in a 32-year-old patient with native CoA and achieved a good outcome. A Palmaz-Schatz stent (XL 10-series 4010; Johnson & Johnson, Warren, NJ, USA) was covered with an Ube woven-graft (WST series; 18 mm across; Ube Junken Medical, Tokyo, Japan). Because the stent shortens when dilated, one end of the graft was firmly sutured to one end of the stent, whereas the other end of the graft was stitched loosely to the other end of the stent so that it could slide along the struts of the stent to accommodate foreshortening. After meticulous in vitro simulations, the covered stent was implanted with right ventricular overdrive pacing. No complications were observed, and the pressure gradient disappeared. These results indicate that angioplasty using a balloon-expandable covered stent is highly safe and effective for correcting native CoA in adult patients and hopefully in children.
在西方国家，建议使用球囊扩张覆膜支架治疗成人先天性主动脉缩窄（CoA），因为血管内裸支架不能完全预防动脉瘤或主动脉破裂等并发症。然而，在日本，没有合适的、经官方批准的此类产品。我们在一名 32 岁的先天性 CoA 患者中开发并使用了一种手工制作的球囊扩张覆膜支架，取得了良好的效果。将 Palmaz-Schatz 支架（XL 10 系列 4010；Johnson & Johnson，Warren，NJ，USA）覆盖一层 Ube 编织移植物（WST 系列；18mm 宽；Ube Junken Medical，Tokyo，Japan）。由于支架扩张时会缩短，因此移植物的一端与支架的一端牢固缝合，而移植物的另一端与支架的另一端松散缝合，以便可以沿着支架的支柱滑动，以适应缩短。经过仔细的体外模拟，用右心室超速起搏植入覆膜支架。未观察到并发症，压力梯度消失。这些结果表明，使用球囊扩张覆膜支架进行血管成形术治疗成人先天性主动脉缩窄非常安全有效，并且有望用于儿童。
