Strauß Lisa, Gibello Lorenzo, Voll Felix, Alvarez-Covarrubias Hector A, Lenz Tobias, Cassese Salvatore, Xhepa Erion, Joner Michael, Schunkert Heribert, Kastrati Adnan, Ruffino Maria Antonella, Kufner Sebastian
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Vascular Surgery Department, University of Turino, Italy.
Cardiovasc Revasc Med. 2025 Jul;76:84-90. doi: 10.1016/j.carrev.2024.09.018. Epub 2024 Oct 18.
The incidence of iatrogenic injuries in peripheral arteries is increasing due to the expanding opportunities of managing various cardiovascular diseases by means of percutaneous intervention. Thus, endovascular repair with implantation of covered stent (CS) after vascular injury is gaining importance as an alternative to open surgery. In cases of smaller side-branch injuries, stenting of the main vessel with subsequent exclusion and sealing of the side-branch is associated with unfavourable revascularization rates and unpredictable ischemic complications in the corresponding supply area.
This study reports the procedural and clinical outcomes of patients with iatrogenic vascular side-branch injuries treated with coronary-CS directly at the site of injury.
This is a retrospective, multicentre registry study, including 40 patients with acute iatrogenic injuries of arterial side-branches undergoing implantation of single-layer polytetrafluorethylene (PTFE)-CS at 3 different centres in Europe between June 2014 and June 2023. Endpoints were procedural success, death, target vessel reintervention (TVR), bleeding and the need for surgical conversion.
A total of 40 patients underwent implantation of single-layer PTFE-CS in the lower (97.5 %) and the upper limbs (2.5 %). The most common mechanisms were injuries after punctures, caused by needle and/or sheath (80 %), balloon-dilations (7.5 %) and during/after non-cardiac surgery (7.5 %). Procedural success was achieved in all cases (100 %). The rate of in-hospital mortality was 7.5 %. The median duration of hospitalization after the CS procedure was 4 days [2; 5.3]. At a median follow-up of 202.5 days [97.3-711.8], 36 patients (90 %) were alive and main vessel patency was 100 %. There were no cases of TVRs, bleedings or surgical conversions. Access-site related complications occurred in 5 % of all cases.
In this study, the use of new-generation single-layer PTFE-covered coronary stents in non-coronary side-branch lesions after iatrogenic arterial injury shows a high technical success rate and favourable clinical efficacy and safety.
由于通过经皮介入治疗各种心血管疾病的机会不断增加，外周动脉医源性损伤的发生率正在上升。因此，血管损伤后植入覆膜支架（CS）进行血管腔内修复作为开放手术的替代方法正变得越来越重要。在较小的侧支损伤病例中，对主血管进行支架置入并随后封闭侧支，会导致相应供血区域的血管再通率不理想以及缺血性并发症不可预测。
本研究报告了在损伤部位直接使用冠状动脉CS治疗医源性血管侧支损伤患者的手术过程和临床结果。
这是一项回顾性多中心注册研究，纳入了2014年6月至2023年6月期间在欧洲3个不同中心接受单层聚四氟乙烯（PTFE）-CS植入术的40例急性医源性动脉侧支损伤患者。观察终点为手术成功率、死亡、靶血管再次干预（TVR）、出血以及转为手术治疗的必要性。
共有40例患者在下肢（97.5%）和上肢（2.5%）植入了单层PTFE-CS。最常见的机制是穿刺后由针和/或鞘引起的损伤（80%）、球囊扩张（7.5%）以及非心脏手术期间/术后（7.5%）。所有病例均获得手术成功（100%）。住院死亡率为7.5%。CS手术后的中位住院时间为4天[2；5.3]。在中位随访202.5天[97.3 - 711.8]时，36例患者（90%）存活，主血管通畅率为100%。没有TVR、出血或转为手术治疗的病例。所有病例中5%发生了与穿刺部位相关的并发症。
在本研究中，新一代单层PTFE覆膜冠状动脉支架用于医源性动脉损伤后的非冠状动脉侧支病变，显示出较高的技术成功率以及良好的临床疗效和安全性。
