Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
Radiology. 2013 Mar;266(3):979-87. doi: 10.1148/radiol.12120517. Epub 2012 Dec 18.
To evaluate outcomes of expanded polytetrafluoroethylene (ePTFE)-covered stents and compare them with outcomes of uncovered stents in patients with malignant superior vena cava (SVC) syndrome.
This study was approved by the institutional review board and written informed consent was obtained. Thirty-seven consecutive patients (33 men, four women; mean age, 60.3 years; range, 35-81 years) who underwent ePTFE-covered stent placement for SVC syndrome were enrolled in a prospective study between January 2009 and September 2011. Their data were compared with retrospective data of 36 consecutive patients (31 men, five women; mean age, 62.3 years; range, 41-81 years) who underwent uncovered stent placement for SVC syndrome between January 2005 and December 2008. The causes of malignant SVC syndrome were squamous cell carcinoma (n = 27), adenocarcinoma (n = 25), small cell carcinoma (n = 15), thymic carcinoma (n = 3), invasive thymoma (n = 2), and breast cancer (n = 1). Stent patency and patient survival rates were calculated by using the Kaplan-Meier method, and groups were compared with the log-rank test.
Stent placement was technically successful in all patients. Complications did not occur in either group. Kaplan-Meier analysis revealed that covered stents had higher cumulative patency (97%, 94%, 94%, and 94% at 1, 3, 6, and 12 months, respectively) than uncovered stents (97%, 79%, 67%, and 48% at 1, 3, 6, and 12 months, respectively; P = .038). Clinical success rates did not significantly differ (P = .674), nor did patient survival (P = .549). Median survival in the covered stent group was 141 days (95% confidence interval: 81, 201 days) and 100 days in the uncovered stent group (95% confidence interval: 60, 140 days).
Endovascular placement of ePTFE-covered stents appeared to be a safe and effective method to treat patients with malignant SVC syndrome and seemed to be superior to uncovered stents in terms of stent patency.
评估聚四氟乙烯（ePTFE）覆膜支架在恶性上腔静脉（SVC）综合征患者中的应用效果，并与非覆膜支架的效果进行比较。
本研究经机构审查委员会批准，并获得了书面知情同意。2009 年 1 月至 2011 年 9 月，连续 37 例（33 例男性，4 例女性；平均年龄 60.3 岁；年龄范围 35-81 岁）因 SVC 综合征接受 ePTFE 覆膜支架置入的患者纳入前瞻性研究，同时回顾性纳入 2005 年 1 月至 2008 年 12 月期间因 SVC 综合征接受非覆膜支架置入的 36 例连续患者（31 例男性，5 例女性；平均年龄 62.3 岁；年龄范围 41-81 岁）。恶性 SVC 综合征的病因包括鳞癌（n=27）、腺癌（n=25）、小细胞癌（n=15）、胸腺癌（n=3）、侵袭性胸腺瘤（n=2）和乳腺癌（n=1）。通过 Kaplan-Meier 法计算支架通畅率和患者生存率，并采用对数秩检验比较组间差异。
所有患者的支架置入技术均成功。两组均未发生并发症。Kaplan-Meier 分析显示，覆膜支架的累积通畅率（1、3、6 和 12 个月时分别为 97%、94%、94%和 94%）高于非覆膜支架（1、3、6 和 12 个月时分别为 97%、79%、67%和 48%；P=0.038）。临床成功率无显著差异（P=0.674），患者生存率也无显著差异（P=0.549）。覆膜支架组的中位生存时间为 141 天（95%置信区间：81-201 天），非覆膜支架组为 100 天（95%置信区间：60-140 天）。
血管内植入 ePTFE 覆膜支架治疗恶性 SVC 综合征是一种安全有效的方法，在支架通畅率方面似乎优于非覆膜支架。
