Košutić Jovan, Prijić Sergej, Vukomanović Vladislav, Rakić Sanja, Kuburović Vladimir
Srp Arh Celok Lek. 2011 Nov-Dec;139(11-12):728-35. doi: 10.2298/sarh1112728k.
Stent implantation, in patients with different forms of aortic coarctation, has significant theoretical advantages over primary balloon dilatation (BD). It can achieve over-dilatation of the coarcted segment with the rigid endoprothesis maintaining the increase in vessel diameter regardless of the intimal injury and, thus, reducing the likelihood of restenosis. Moreover, by preventing vascular recoil, stents can successfully expand long-segment tubular coarctations, hypoplastic isthmus and hypoplastic transverse aortic arch. Finally, by facilitating good apposition of the torn intima to the aortic wall, they can significantly reduce the incidence of aneurysm formation.
Evaluation of the immediate and mid-term results of stent implantation in patients with different forms of aortic coarctation.
Between February 2005 and March 2010 eleven stents were implanted in nine patients (two female and seven male) either with post surgical or post primary BD residual coarctation/recoarctation or with native aortic coarcatation. Mean age of our patients was 14 +/- 3 years (9.4-18.1 years) and mean body weight 54 +/- 18 kg (29-76 kg).
Pressure gradient across the coarctation site was reduced from 24.9 +/- 12.4 mm Hg before to 3.9 +/- 5.0 mm Hg after stenting (p = 0.000). There were no complications. Mean followup was 2.0 +/- 1.5 years (range 0.1-5.2 years). In patients with localised aortic arch narrowing no restenosis or aneurysm formation was observed (residual pressure gradient 0-5 mm Hg).
In properly selected children (body weight > 25 kg), adolescents and young adults stenting is the method of choice for patients with various forms of aortic arch obstruction.
对于不同类型主动脉缩窄的患者，支架植入术相较于单纯球囊扩张术（BD）具有显著的理论优势。使用刚性内置假体可实现缩窄段的过度扩张，无论内膜损伤情况如何，均可维持血管直径的增加，从而降低再狭窄的可能性。此外，通过防止血管回缩，支架能够成功扩张长段管状缩窄、发育不全的峡部以及发育不全的主动脉弓横部。最后，通过促进撕裂的内膜与主动脉壁良好贴合，可显著降低动脉瘤形成的发生率。
评估不同类型主动脉缩窄患者支架植入术的近期和中期效果。
2005年2月至2010年3月期间，对9例患者（2例女性，7例男性）植入了11枚支架，这些患者要么是手术后或初次球囊扩张术后残留缩窄/再缩窄，要么是先天性主动脉缩窄。患者的平均年龄为14±3岁（9.4 - 18.1岁），平均体重为54±18千克（29 - 76千克）。
缩窄部位的压力梯度从支架植入前的24.9±12.4毫米汞柱降至植入后的3.9±5.0毫米汞柱（p = 0.000）。未出现并发症。平均随访时间为2.0±1.5年（范围0.1 - 5.2年）。在局限性主动脉弓狭窄患者中，未观察到再狭窄或动脉瘤形成（残留压力梯度为0 - 5毫米汞柱）。
对于经过适当选择的儿童（体重>25千克）、青少年和年轻成年人，支架植入术是各种类型主动脉弓梗阻患者的首选治疗方法。
