The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Am J Cardiol. 2012 Nov 15;110(10):1541-5. doi: 10.1016/j.amjcard.2012.06.063. Epub 2012 Jul 30.
Surgical treatment of pediatric acute traumatic aortic injury (TAI) after blunt chest trauma is standard of care. Use of endovascular stent grafts for treatment of TAI in adults is common but has important limitations in children. We sought to describe the use of balloon-expandable covered endovascular stents for treatment of TAI in children and adolescents. Participants of the multicenter Coarctation of the Aorta Stent Trial (COAST) had access to investigational large-diameter, balloon-expandable, covered stents (covered Cheatham-platinum stents; NuMed, Inc., Hopkinton, New York) on an emergency-use basis. From 2008 through 2011, 6 covered stents were implanted in 4 patients at 3 COAST centers for treatment of TAI. Median patient age was 13.5 years (range 11 to 14) and weight was 58 kg (40 to 130). All patients sustained severe extracardiac injuries that were judged to preclude safe open surgical repair of TAI. Median aortic isthmus and stent implantation balloon diameters were 16.4 mm (13.2 to 19) and 19 mm (16 to 20), respectively. Stent implantation was technically successful in all attempts. Complete exclusion of aortic wall injury was achieved in all cases. There were no access site complications. At a median follow-up of 24 months, there was 1 early death (related to underlying head trauma) and 1 patient with recurrent aortic aneurysm who required additional stent implantation. In conclusion, balloon-expandable covered-stent implantation for treatment of pediatric TAI after blunt trauma is generally safe and effective. Availability of this equipment may alter the standard approach to treatment of pediatric TAI.
经胸部钝性创伤后，对儿科急性创伤性主动脉损伤（TAI）进行手术治疗是标准治疗方法。在成人中，使用血管内支架移植物治疗 TAI 较为常见，但在儿童中存在重要限制。我们旨在描述使用球囊扩张式覆膜血管内支架治疗儿童和青少年 TAI。主动脉缩窄支架试验（COAST）的多中心参与者可在紧急情况下获得研究用大直径球囊扩张式覆膜支架（覆膜 Cheatham-platinum 支架；NuMed，Inc.，纽约州霍普金顿）。2008 年至 2011 年，在 3 个 COAST 中心，有 4 名患者因 TAI 而植入了 6 个覆膜支架。中位患者年龄为 13.5 岁（范围 11 至 14），体重为 58kg（40 至 130）。所有患者均有严重的心脏外损伤，这些损伤被认为不能安全地进行 TAI 的开放式外科修复。主动脉峡部和支架植入球囊的直径中位数分别为 16.4mm（13.2 至 19）和 19mm（16 至 20）。所有尝试均成功地进行了支架植入。所有病例均完全排除了主动脉壁损伤。无入路并发症。中位随访 24 个月时，有 1 例早期死亡（与基础头部创伤有关）和 1 例因复发性主动脉瘤而再次需要支架植入的患者。总之，球囊扩张式覆膜支架植入术治疗钝性创伤后儿科 TAI 通常是安全有效的。这种设备的可用性可能会改变儿科 TAI 的标准治疗方法。
