From the Department of Pediatrics, Seattle Children's Hospital, WA (B.H.M.); Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (D.B.M.); and Department of Cardiology, Boston Children's Hospital, Boston, MA (A.C.M., D.P.).
Circ Cardiovasc Interv. 2016 Apr;9(4):e003281. doi: 10.1161/CIRCINTERVENTIONS.115.003281.
Treatment with endovascular stents has become increasingly common for the management of vascular stenosis in congenital heart disease. The use of stents in smaller patients has been tempered by concerns about the potential for stent expansion to accommodate somatic growth. One solution to limited stent diameter is the intentional fracture of maximally dilated stents, which can be accomplished using ultra-high-pressure (UHP) balloons.
This retrospective cohort study compared procedural characteristics and adverse events between a cohort of patients with branch pulmonary artery (PA) stents who underwent stent fracture using UHP balloons and control patients who underwent UHP redilation of previously placed PA stents without stent fracture between 2004 and 2014. Two control patients were selected for every case. Thirty-three PA stents were fractured in 31 patients with a median of 10 years after initial stent placement. The median balloon:waist ratio was 1.17 (1-1.71), and the median inflation pressure was 20 (8-30) atm. There were significant reductions in pressure gradient after angioplasty, with no difference in postangioplasty gradients between cases and controls. There were no major PA complications in the stent fracture group and no difference in the number of adverse events between the 2 groups.
In this small series, PA stent fracture using UHP balloon angioplasty was feasible and did not result in major complications although predictors of successful fracture were not identified. Intentional fracture with UHP balloon angioplasty may be considered when treating stents that have become restrictive despite maximal dilation.
血管内支架治疗已成为先天性心脏病血管狭窄治疗的常用方法。由于担心支架扩张以适应躯体生长的能力，在较小的患者中使用支架受到了限制。解决支架直径有限的一个方法是有意折断最大限度扩张的支架，这可以使用超高压力（UHP）球囊来完成。
这项回顾性队列研究比较了 2004 年至 2014 年间接受 UHP 球囊支架断裂治疗的分支肺动脉（PA）支架患者和接受 UHP 重新扩张但未进行支架断裂的先前放置的 PA 支架的对照组患者的手术特征和不良事件。每个病例选择了两名对照组患者。31 例患者中有 33 个 PA 支架发生断裂，平均在初始支架放置后 10 年。球囊：腰部比中位数为 1.17（1-1.71），平均充气压力为 20（8-30）大气压。血管成形术后压力梯度明显降低，病例组和对照组之间的血管成形术后梯度无差异。支架断裂组无严重 PA 并发症，两组不良事件数量无差异。
在这个小系列中，使用 UHP 球囊血管成形术进行 PA 支架断裂是可行的，尽管没有确定成功断裂的预测因素，但没有导致重大并发症。在最大扩张后仍然出现限制的支架治疗中，可以考虑使用 UHP 球囊血管成形术进行有意折断。
