Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, California, USA.
2UCI/CS CHOC Children's Hospital.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):451-458. doi: 10.1002/ccd.29421. Epub 2020 Dec 7.
To determine over-dilation potential of commercially available covered stents.
Covered stents including the Atrium iCast, Gore VBX, and Lifestream stents (LS) can treat ruptures, dissections, and aneurysms in small vessels. Especially in growing patients, stents often require serial dilations beyond their implant or nominal diameters. Tolerance of serial dilations is clinically important information for interventionalists.
Serial dilations of 5-12 mm iCast, VBX, and LS covered stents were performed in 1-2 mm increments (up to 20 mm). With each dilation, foreshortening and recoil were measured, and stent strut and covering integrity were assessed. High-pressure balloons were used to expand the stents until they fractured or could not be further expanded.
The 5-8 mm LS tolerated dilation to 14.5-16 mm. The 10-12 mm LS stents tolerated dilation to 18 mm and fractured on the 20 mm balloon. LS stents foreshortened 35%-45% on average after 8 mm of over-dilation and had 5%-10% recoil on <6 mm over-dilation. All iCast stents tolerated dilation to 12-13 mm and required fracture for dilation to >14 mm. ICast stents foreshortened 19%-29% at maximum dilation, with 3-6% recoil on <2 mm over-dilation, and < 3% thereafter. VBX stents over-dilated to 2.9-4.7 mm above nominal, foreshortening 40%-50% after 4-6 mm of over-dilation before collapsing into a ring. VBX stent recoil was <2.5% on all dilations.
LS stents had the greatest over-dilation potential. VBX stents had the least recoil but tended to foreshorten significantly 3-4 mm above nominal. Regardless of nominal size, all iCast stents (including the 5 mm) tolerated dilation to a maximum of 12-13 mm.
确定市售覆膜支架的过度扩张潜力。
覆膜支架，包括 Atrium iCast、Gore VBX 和 Lifestream 支架（LS），可用于治疗小血管的破裂、夹层和动脉瘤。特别是在生长中的患者中，支架往往需要在其植入或标称直径之外进行多次扩张。对多次扩张的耐受性是介入医生的重要临床信息。
对 5-12mm 的 iCast、VBX 和 LS 覆膜支架进行 1-2mm 的递增扩张（最大 20mm）。每次扩张时，测量缩短和回缩，并评估支架支柱和覆盖物的完整性。使用高压球囊扩张支架，直至支架破裂或无法进一步扩张。
5-8mm 的 LS 支架可耐受扩张至 14.5-16mm。10-12mm 的 LS 支架可耐受扩张至 18mm，并在 20mm 球囊上破裂。LS 支架在过度扩张 8mm 后平均缩短 35%-45%，在<6mm 的过度扩张时有 5%-10%的回缩。所有 iCast 支架均耐受扩张至 12-13mm，需要断裂才能扩张至>14mm。iCast 支架在最大扩张时缩短 19%-29%，在<2mm 的过度扩张时有 3-6%的回缩，之后<3%。VBX 支架过度扩张至标称直径以上 2.9-4.7mm，在 4-6mm 的过度扩张后缩短 40%-50%，然后缩成一个环。VBX 支架在所有扩张时的回缩均<2.5%。
LS 支架的过度扩张潜力最大。VBX 支架的回缩最小，但在标称直径以上 3-4mm 处往往会显著缩短。无论标称尺寸如何，所有 iCast 支架（包括 5mm）均能耐受最大 12-13mm 的扩张。
