Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
EuroIntervention. 2015 Oct;11(6):660-8. doi: 10.4244/EIJV11I6A133.
Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually reported in small retrospective case series. This systematic review provides an overview of clinical experience with stenting for CoA.
A systematic review of the reports published between January 1990 and December 2014 after stenting a CoA was performed with a focus on relief of obstruction and lowering of blood pressure. Study and patient characteristics were extracted, as well as pre- and post-stenting aortic diameter in mm, systolic pressure gradient (SPG) and pre- and post-stenting systolic blood pressure (mmHg), periprocedural and follow-up complications. Forty-five articles met the inclusion criteria. Three outcomes were extracted from the articles - aortic diameter, systolic pressure gradient and blood pressure. Diameter increased from 6.4 mm (5.6, 7.3) to 15.1 mm (14.5, 15.7), pressure gradients decreased from 40 mmHg (35, 42) to 4 mmHg (3, 5) and systolic blood pressure decreased from 153 mmHg (148, 158) to 132 mmHg (127, 136). Stent migration was the most common periprocedural complication (2.4%), and mortality was low (0.4%).
Stenting is an effective treatment with regard to immediate relief of obstruction and direct lowering effect on blood pressure. However, there is a lack of evidence regarding late effectiveness concerning durable blood pressure lowering, and limited information on periprocedural and late complications. This observation calls for a systematic and longer prospective follow-up of patients after CoA stenting.
在过去的 20 年中，支架置入术已成为治疗主动脉缩窄（CoA）的更常见选择。CoA 支架置入术的临床结果通常在小型回顾性病例系列中报告。本系统评价提供了 CoA 支架置入术临床经验的概述。
对 1990 年 1 月至 2014 年 12 月期间发表的 CoA 支架置入后报告进行了系统评价，重点关注梗阻缓解和血压降低。提取研究和患者特征，以及支架置入前后的主动脉直径（mm）、收缩压梯度（SPG）和支架置入前后的收缩压（mmHg）、围手术期和随访并发症。45 篇文章符合纳入标准。从文章中提取了 3 个结果 - 主动脉直径、收缩压梯度和血压。直径从 6.4mm（5.6，7.3）增加到 15.1mm（14.5，15.7），压力梯度从 40mmHg（35，42）降低到 4mmHg（3，5），收缩压从 153mmHg（148，158）降低到 132mmHg（127，136）。支架移位是最常见的围手术期并发症（2.4%），死亡率较低（0.4%）。
支架置入术在立即缓解梗阻和直接降低血压方面是一种有效的治疗方法。然而，关于持久降压的后期效果缺乏证据，并且关于围手术期和晚期并发症的信息有限。这种观察结果呼吁对 CoA 支架置入后的患者进行系统和更长时间的前瞻性随访。
