Fogelman R, Nykanen D, Smallhorn J F, McCrindle B W, Freedom R M, Benson L N
University of Toronto, Faculty of Medicine, Department of Pediatrics, Ontario, Canada.
Circulation. 1995 Aug 15;92(4):881-5. doi: 10.1161/01.cir.92.4.881.
The use of endovascular stents to relieve obstructions in the setting of non-balloon dilatable pulmonary artery stenosis has been encouraging. The benefits in management and the potential for restenosis, however, have not been defined. This study attempts to assess the impact of such implants on clinical outcomes and the pattern of stent incorporation within the vessel wall.
Fifty-five balloon-expandable stents were implanted in 42 patients 6.1 +/- 4.7 years of age. Patients were followed prospectively (median, 15 months) and recatheterized 1 year after implantation. Thirty-eight patients had the implants positioned percutaneously (49 implants), while 4 patients (6 implants) had intraoperative implantations. There was a diameter increase in the stenotic area of 109 +/- 79% (P < .0001) and a gradient reduction of 74 +/- 26% (P < .0001). Twelve stents straddled the orifice of side-branch pulmonary arteries and reduced flow to the branch vessel acutely in 7 patients. Twenty-nine patients underwent recatheterization, and various degrees and locations of acquired intraluminal narrowing were observed in all cases, particularly in areas of diameter mismatch between the stented and nonstented vessels. Eleven patients had further dilation with diameter improvement. Of the 38 patients who underwent percutaneous implantation, planned surgery for pulmonary artery stenosis was avoided in 33 and deferred in 4 patients. One patient who was considered inoperable had stent implantation as a palliative procedure. Symptomatic improvement was reported in 27 patients, and 15 patients remained asymptomatic.
Endovascular stents have a role in the treatment of pulmonary artery stenoses and positively affect clinical care. The stenosis relief, however, may be tempered by the development of intraluminal stent obstruction, which may require redilation (15 of 55 stents) and mandates long-term follow-up.
在不可球囊扩张的肺动脉狭窄情况下，使用血管内支架来缓解梗阻一直令人鼓舞。然而，其在治疗中的益处以及再狭窄的可能性尚未明确。本研究试图评估此类植入物对临床结局的影响以及支架在血管壁内的整合模式。
在42例年龄为6.1±4.7岁的患者中植入了55个球囊扩张支架。对患者进行前瞻性随访（中位时间为15个月），并在植入后1年再次进行心导管检查。38例患者经皮植入支架（49个支架），而4例患者（6个支架）在术中植入。狭窄区域直径增加了109±79%（P<.0001），压力阶差降低了74±26%（P<.0001）。12个支架跨越了肺侧支动脉的开口，7例患者的分支血管血流急性减少。29例患者接受了再次心导管检查，所有病例均观察到不同程度和部位的获得性管腔内狭窄，特别是在支架置入血管与未置入血管直径不匹配的区域。11例患者进行了进一步扩张，直径有所改善。在38例经皮植入的患者中，33例避免了计划中的肺动脉狭窄手术，4例手术延期。1例被认为无法手术的患者接受了支架植入作为姑息治疗。27例患者报告症状改善，15例患者仍无症状。
血管内支架在肺动脉狭窄的治疗中具有作用，并对临床治疗产生积极影响。然而，狭窄的缓解可能会因管腔内支架阻塞的发生而受到影响，这可能需要再次扩张（55个支架中的15个），并需要长期随访。
