Herrera Mingorance Jose Damian, Pérez Bailón Ana María, Moreno Escobar Jose Maria, Salmerón Febres Luis Miguel
Hospital Universitario Clínico San Cecilio, Granada, Spain.
Hospital Universitario Virgen de las Nieves, Granada, Spain.
EJVES Vasc Forum. 2022 Feb 23;55:23-26. doi: 10.1016/j.ejvsvf.2022.02.005. eCollection 2022.
Coarctation of the aorta (CoA) is one of the more common congenital heart defects that usually manifests in adults as poorly controlled hypertension. When technically possible, the treatment of choice for adult CoA is an endovascular approach with covered stent placement. A case is presented with atypical clinical onset, treated endovascularly with a double layer stent technique.
A 41 year old previously asymptomatic woman with an unremarkable past medical history presented with sudden dyspnoea, unstable blood pressure and pulse, and a radial femoral systolic pressure difference of 53 mmHg. A computed tomography scan showed coral reef aorta: aortic stenosis from a highly calcified lesion located distal to the origin of the left subclavian artery, compatible with CoA. Within a few hours, the patient went rapidly into cardiogenic shock with multiple organ failure requiring urgent intervention. Using a dual left iliac conduit and right brachial artery access, the lesion was pre-dilated with an 8 × 60 mm balloon. A double layer technique was then applied by coaxially deploying a BeGraft aortic stent (expanded to 18 mm) followed by a Conformable GORE® TAG® thoracic stent graft (26 × 26 × 100 mm). The patient's symptoms improved and the radial femoral systolic gradient decreased to 12 mmHg.
Sudden onset CoA is a rare condition in adults that can lead to refractory cardiogenic shock and multiple organ failure. In anatomically complex cases, a double layer technique may be beneficial because it has high radial force and good wall apposition with lower risk of stent collapse than single stent deployment.
主动脉缩窄（CoA）是较常见的先天性心脏缺陷之一，在成人中通常表现为难以控制的高血压。在技术可行的情况下，成人CoA的首选治疗方法是采用带覆膜支架置入的血管内介入治疗。本文报告1例非典型临床起病的病例，采用双层支架技术进行血管内治疗。
一名41岁既往无症状、既往病史无异常的女性，出现突发呼吸困难、血压和脉搏不稳定，桡动脉与股动脉收缩压差为53 mmHg。计算机断层扫描显示为珊瑚礁样主动脉：左锁骨下动脉起源远端的高度钙化病变导致主动脉狭窄，符合主动脉缩窄表现。数小时内，患者迅速发展为心源性休克并伴有多器官功能衰竭，需要紧急干预。通过左髂总动脉双导管和右肱动脉入路，用8×60 mm球囊对病变进行预扩张。然后采用双层技术，同轴部署一个BeGraft主动脉支架（扩张至18 mm），随后部署一个适形GORE® TAG®胸主动脉覆膜支架（26×26×100 mm）。患者症状改善，桡动脉与股动脉收缩压差降至12 mmHg。
成人突发性主动脉缩窄是一种罕见疾病，可导致难治性心源性休克和多器官功能衰竭。在解剖结构复杂的病例中，双层技术可能有益，因为它具有较高的径向支撑力和良好的贴壁性，与单支架置入相比，支架塌陷风险更低。
