Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois 60612, USA.
Catheter Cardiovasc Interv. 2011 Sep 1;78(3):413-8. doi: 10.1002/ccd.22999.
We describe our experience with self-fabricated covered stents in the setting of coarctation of the aorta (CoA).
Balloon-expandable covered stents are increasingly being utilized to treat CoA in older children and adults. These stents however, are not available in the United States limiting the interventionalist's ability to treat this condition safely and effectively.
Retrospective analysis and follow-up data review of our complete experience with self-fabricated covered stents for CoA. Stents were fashioned by suturing an appropriate length of tubular polytetraflouroethylene to a bare metal stent and deploying this stent across the coarctation in a standardized fashion.
Over a 9-year period we implanted 53 balloon-expandable stents in 49 patients with CoA. Of these 13 were self-fabricated covered stents deployed in 13 patients (7 male). Median age at implantation was 25.4 years (range, 8.7-49.5 years) with median weight of 65.5 kg (range, 28-168 kg). Indications for stent placement were native coarctation/aortic atresia (n = 9), aneurysm formation (n = 3), and re-coarctation (n = 1). The median systolic pressure gradient across the coarctation of 33 mm Hg (range, 12-69 mm Hg) was reduced to 3 mm Hg (range, 0-19 mm Hg) post procedure (P < 0.001). There were no deaths on median follow-up of 44 months (range, 1-83 months). One patient developed acute contained extravasation at implantation, treated with a self-expanding stent graft. Another patient required thrombectomy for femoral arterial thrombosis.
Innovative application of available materials adds to the armamentarium of the interventionalist. Our self-fabricated covered stent provides effective gradient reduction with no compromise in stent delivery or durability on follow-up.
我们介绍在主动脉缩窄（CoA）中使用自制覆膜支架的经验。
球囊扩张覆膜支架越来越多地用于治疗大龄儿童和成人的 CoA。然而，这些支架在美国不可用，限制了介入医生安全有效地治疗这种疾病的能力。
回顾性分析和随访数据回顾我们使用自制覆膜支架治疗 CoA 的完整经验。支架通过将适当长度的管状聚四氟乙烯缝合到裸金属支架上来制作，并以标准化的方式将其部署在缩窄处。
在 9 年期间，我们在 49 例 CoA 患者中植入了 53 个球囊扩张支架。其中 13 例是在 13 例患者（7 例男性）中植入的自制覆膜支架。植入时的中位年龄为 25.4 岁（范围，8.7-49.5 岁），中位体重为 65.5kg（范围，28-168kg）。支架置入的指征为：先天性缩窄/主动脉闭锁（n=9）、动脉瘤形成（n=3）和再缩窄（n=1）。缩窄处的中位收缩压梯度为 33mmHg（范围，12-69mmHg），术后降至 3mmHg（范围，0-19mmHg）（P<0.001）。在中位随访 44 个月（范围，1-83 个月）期间，无死亡。1 例患者在植入时发生急性包裹性外渗，用自膨式支架移植物治疗。另 1 例患者因股动脉血栓形成需要血栓切除术。
对现有材料的创新性应用增加了介入医生的治疗手段。我们的自制覆膜支架可有效降低梯度，在随访中不影响支架输送或耐久性。
