Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.).
Center for Biostatistics Department of Biomedical Informatics, The Ohio State University, Columbus (S.A.J.).
Circ Cardiovasc Interv. 2021 Feb;14(2):e009399. doi: 10.1161/CIRCINTERVENTIONS.120.009399. Epub 2021 Feb 5.
Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients.
A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed.
Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3-7.9) years and 10 (5.5-20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18-42] to 0 mm Hg [IQR, 0-2]; < 0.05) and median minimum diameter (3.6 mm [IQR, 2.4-4.8] to 7.7 mm [IQR, 6.5-9.4]; <0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5-63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8-116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion.
Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.
支架植入术（SI）比球囊血管成形术治疗主动脉缩窄（CoA）更有效。由于技术因素，球囊血管成形术在小患者中更为常见。我们旨在评估在小患者中使用经皮成人尺寸 SI 治疗 CoA 的结果。
对 2004 年至 2015 年期间因先天性或复发性 CoA 接受经皮成人尺寸 SI 的所有≤20kg 患者进行了单中心回顾性研究。
共确定了 39 例患者（20 例患者≤10kg），其中 28 例（71.8%）患有复发性 CoA，22 例（56.4%）先前球囊血管成形术失败。在 SI 时，患者的中位（范围）年龄和体重分别为 1.1（0.3-7.9）岁和 10（5.5-20.4）kg。SI 导致中位梯度显著改善（26mmHg[四分位距（IQR），18-42]至 0mmHg[IQR，0-2]；<0.05）和最小直径的中位数（3.6mm[IQR，2.4-4.8]至 7.7mm[IQR，6.5-9.4]；<0.05）。7 例患者（18%）发生了程序不良事件。27 例（69%）患者在 SI 后中位时间 49.3（IQR，26.5-63.2）个月进行了选择性再干预，其中 8 例（21%）支架因支架断裂需要重复 SI。在中位随访 67.2（IQR，33.8-116.1）个月后，25 例患者（69%）无高血压或血压梯度。3 例（11%）患者发生股动脉闭塞。
成人尺寸 SI 是治疗 CoA 小患者的手术干预替代方法。SI 存在与入路相关的并发症风险，随着具有成人尺寸最大直径的更低轮廓支架的发展，这种风险可能会降低。
