Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain.
Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain.
JACC Cardiovasc Interv. 2015 Aug 24;8(10):1368-1379. doi: 10.1016/j.jcin.2015.05.018.
This study sought to determine whether several anatomic or evolving characteristics of the coarctation may create challenging conditions for treatment.
Stent repair of coarctation of aorta is an alternative to surgical correction.
We analyzed our 21-year experience in the percutaneous treatment of complex coarctation of aorta. Adverse conditions for treatment were as follow: 1) complete interruption of the aortic arch (n = 11); 2) associated aneurysm (n = 18); 3) complex stenosis (n = 30); and 4) the need for re-expansion and/or restenting (n = 21). Twenty patients (33%) belonged to more than 1 group. Ten interruptions were type A and 1 was type B. The mean length of the interrupted aorta was 9 ± 11 mm. The associated aneurysms were native in 8 patients and after previous intervention in 10 patients. Aneurysm shapes were fusiform in 8 patients and saccular in 10. The following characteristics defined complex stenosis as long diffuse stenosis, very tortuous coarctation, or stenosis involving a main branch or an unusual location. Patients previously stented at an early age, required re-expansion and/or restenting after reaching 16 ± 5 years of age.
Two patients had died by 1-month follow-up. The remaining 58 patients did well and were followed-up for a mean period of 10 ± 6 years. Late adverse events occurred in 3 patients (5%). All remaining patients are symptom-free, with normal baseline blood pressure. Imaging techniques revealed good patency at follow-up without associated aneurysm or restenosis. The actuarial survival free probability of all complex patients at 15 years was 92%.
Stent repair of complex coarctation of aorta is feasible and safe. Initial results are maintained at later follow-up.
本研究旨在确定缩窄的几个解剖或演变特征是否会给治疗带来挑战。
支架修复主动脉缩窄是手术矫正的替代方法。
我们分析了我们在经皮治疗复杂主动脉缩窄的 21 年经验。治疗的不利条件如下：1）主动脉弓完全中断（n=11）；2）伴发动脉瘤（n=18）；3）复杂狭窄（n=30）；4）需要重新扩张和/或再次支架置入（n=21）。20 例（33%）患者属于多个组。10 例中断为 A 型，1 例为 B 型。中断主动脉的平均长度为 9±11mm。伴发的动脉瘤在 8 例中为原发性，在 10 例中为既往介入后。动脉瘤形状在 8 例中为梭形，在 10 例中为囊状。以下特征将长弥漫性狭窄、严重迂曲缩窄、狭窄累及主要分支或不常见位置定义为复杂狭窄。患者在早年曾支架置入，在 16±5 岁后需要再次扩张和/或再次支架置入。
2 例患者在 1 个月随访时死亡。其余 58 例患者情况良好，平均随访 10±6 年。3 例（5%）患者出现晚期不良事件。所有其余患者均无症状，基础血压正常。影像学技术显示随访时通畅良好，无伴发动脉瘤或再狭窄。所有复杂患者的 15 年总生存率为 92%。
支架修复复杂主动脉缩窄是可行且安全的。初始结果在后期随访中得以维持。
