Trent M S, Parsonnet V, Shoenfeld R, Brener B J, Eisenbud D E, Novick A S, Campbell A Y, Ferrara-Ryan M, Villanueva A
Division of Vascular Surgery, Newark Beth Israel Medical Center, NJ 07112.
J Vasc Surg. 1990 May;11(5):707-17.
Acute aortic dissection is a life-threatening condition. Aggressive hypotensive drug therapy is the initial treatment of choice, although emergent surgical intervention is often warranted. We evaluated the efficacy of a balloon-expandable intravascular stent for the internal obliteration of aortic dissection. It is a flexible, continuous, complex coil cut to the length needed at the time of insertion. It can be positioned in curved vessels, including the aortic arch. The stent was inserted in the thoracic and abdominal aorta of 12 dogs (group I). Six weeks after implantation the dogs underwent angiography and the stents were explanted for light and scanning electron microscopy. There were no instances of stent migration or change in configuration. The aortas did not rupture. All branch vessels remained patent. Light and scanning electron microscopy illustrated neointimal incorporation into the vascular wall except at orifices. Thoracic dissections were created surgically in an additional 24 mongrel dogs. Twelve dogs received stents immediately after creation of the dissection (group II). All 12 dissections were obliterated. Twelve dogs were allowed to recover after creation of the dissection to observe the natural history of that lesion (group III). Within 1 week, in group III, there were three deaths because of aortic rupture; eight dissections persisted, and one resealed spontaneously. Stents were placed in the eight persistent dissections. All eight dissections were obliterated. In both groups, after 6 weeks of stent placement, aortography was repeated, and stents were explanted for light and scanning electron microscopy. There were no instances of rupture. All branch vessels remained patent with no evidence of thrombosis. We conclude that because of its unique characteristics, the stent effectively obliterates the false lumen of experimental acute aortic dissections without occlusing side branches, damaging the aorta, or inducing thrombosis.
急性主动脉夹层是一种危及生命的疾病。积极的降压药物治疗是首选的初始治疗方法，尽管通常需要紧急手术干预。我们评估了一种球囊可扩张血管内支架用于主动脉夹层腔内闭塞的疗效。它是一种灵活、连续、复杂的线圈，在插入时可切割成所需长度。它可以放置在包括主动脉弓在内的弯曲血管中。将支架植入12只犬的胸主动脉和腹主动脉（I组）。植入六周后，对犬进行血管造影，并取出支架进行光学显微镜和扫描电子显微镜检查。没有发生支架移位或构型改变的情况。主动脉未破裂。所有分支血管均保持通畅。光学显微镜和扫描电子显微镜显示，除开口处外，新生内膜已融入血管壁。另外对24只杂种犬进行手术制造胸主动脉夹层。12只犬在制造夹层后立即植入支架（II组）。所有12个夹层均被闭塞。12只犬在制造夹层后让其恢复，以观察该病变的自然病程（III组）。在III组中，1周内有3只因主动脉破裂死亡；8个夹层持续存在，1个夹层自发重新闭合。对8个持续存在的夹层放置支架。所有8个夹层均被闭塞。在两组中，支架植入6周后，重复进行主动脉造影，并取出支架进行光学显微镜和扫描电子显微镜检查。没有破裂情况发生。所有分支血管均保持通畅，无血栓形成迹象。我们得出结论，由于其独特的特性，该支架可有效闭塞实验性急性主动脉夹层的假腔，而不会阻塞侧支血管、损伤主动脉或诱发血栓形成。
