Clinical Department of Cardiovascular diseases, University Hospitals Leuven, Leuven, Belgium.
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Acta Cardiol. 2021 Jul;76(5):464-472. doi: 10.1080/00015385.2020.1838126. Epub 2020 Oct 28.
This study aimed to describe the safety and efficacy of covered stents in patients with coarctation of aorta (CoA) for immediate and long-term follow-up.
Covered stents are increasingly being used in (re)CoA, mainly to reduce the risk of aortic wall injuries (AWI). However, limited data are available on intermediate and long-term outcome.
In 89 patients (67.4% male) with a mean age of 23.9 ± 15.8 (min max range 5.1-71.6) years were 102 covered stents implanted (January 2003 - December 2017). Short-term pre/post-implant hemodynamics and angiographic data were reported. Changes in blood pressure, the use of antihypertensive drugs and complications were recorded during follow-up.
The procedural success rate was 100%. The mean invasive ascending-to-descending aorta systolic gradient under general anaesthesia decreased from 25 ± 16 mmHg to 4 ± 7 mmHg ( < 0.001). After a mean follow-up time of 6.6 ± 3.7 years, there was a persistent improvement of the mean systolic blood pressure gradient between right arm and leg (-7 ± 18 vs 38 ± 24 mmHg; < 0.001). A larger proportion of patients required antihypertensive medication (33.7% vs 50.0%, = 0.017) and needed ≥ 2 drugs (20.2% vs 27.4%, = 0.066) to control blood pressure. Long-term adverse events were found in 4.5% of patients [covered stent fracture ( = 3), aneurysm formation ( = 2)].
Covered stent implantation for CoA is highly successful, safe and results in a persistent hemodynamic improvement in the immediate and long-term outcome. Lifelong follow-up with additional antihypertensive drug treatment is mandatory to maintain favourable hemodynamic results after stenting.
Long-term follow-up data on covered stents in patients with coarctation of the aorta are scarce. A cohort of 89 patients was reviewed. The procedural implantation success rate was 100%. The invasive gradient decreased from 25 ± 16 mmHg to 4 ± 7 mmHg ( < 0.001). After follow-up of 6.6 ± 3.7 years, there was a persistent improvement of the clinical systolic blood pressure gradient (-7 ± 18 vs 38 ± 24 mmHg; < 0.001). However, a larger proportion of patients required antihypertensive medication (33.7% vs 50.0%, = 0.017). Covered stent implantation results in favourable hemodynamic effects, but lifelong follow-up with additional antihypertensive drug treatment is mandatory to maintain these results.
本研究旨在描述主动脉缩窄（CoA）患者使用覆膜支架的安全性和疗效，随访时间包括即刻和长期。
覆膜支架在（再）CoA 中的应用日益增多，主要是为了降低主动脉壁损伤（AWI）的风险。然而，目前关于中期和长期结果的数据有限。
89 例患者（67.4%为男性），平均年龄 23.9±15.8 岁（最小至最大年龄范围为 5.1-71.6 岁），共植入 102 枚覆膜支架（2003 年 1 月至 2017 年 12 月）。报道了短期植入前后的血流动力学和血管造影数据。记录了随访期间血压的变化、降压药物的使用和并发症。
手术成功率为 100%。在全身麻醉下，平均升主动脉至降主动脉收缩期梯度从 25±16mmHg 降至 4±7mmHg（ < 0.001）。平均随访 6.6±3.7 年后，右侧上肢和下肢的平均收缩压梯度持续改善（-7±18 对 38±24mmHg； < 0.001）。需要降压药物的患者比例更大（33.7%对 50.0%， = 0.017），需要≥2种药物控制血压的患者比例更高（20.2%对 27.4%， = 0.066）。4.5%的患者出现远期不良事件[覆膜支架断裂（ = 3），动脉瘤形成（ = 2）]。
覆膜支架植入治疗主动脉缩窄非常成功、安全，即刻和长期结果均能持续改善血流动力学。为了维持支架置入后的有利血流动力学结果，必须进行长期随访并加用降压药物治疗。
