Ing F F, Grifka R G, Nihill M R, Mullins C E
Schneider Children's Hospital, Department of Pediatric Cardiology, New Hyde Park, NY, USA.
Circulation. 1995 Aug 15;92(4):893-7. doi: 10.1161/01.cir.92.4.893.
Intravascular (Palmaz) stents have been successfully implanted in patients with congenital and acquired branch pulmonary stenosis. Early results are excellent; however, there is no information on restenosis and repeat dilation in patients with congenital heart disease. The purpose of this study is to review the incidence of restenosis and demonstrate the safety and efficacy of repeat dilation of stents in this group of patients.
Of 94 patients with 163 implanted stents in this single-center study, 43 patients with 73 implanted stents underwent recatheterization. Only 2 of 73 restudied stents (3%) developed significant restenosis. In 20 patients, 30 stents were redilated. At stent implantation, the mean age of this subgroup was 14.2 years, the mean intraluminal diameter increased from 4.9 to 10.7 mm (P = .0001), and the systolic gradient (mean) across the stent decreased from 52 to 11 mm Hg (P = .0001). At recatheterization (mean, 13 months), all stents were patent. The mean diameter decreased by 1.2 mm (P = .0001), but the increase in the gradient (mean, 3 mm Hg) was not significant (P = .11). After repeat dilation, the diameter increased from 9.5 to 12.2 mm (P = .0001), and the gradient decreased from 14 to 8 mm Hg (P = .0003). The 2 stents with restenosis were redilated successfully. Two patients underwent a successful second redilation of 3 stents at 18 and 26 months. There were no complications.
All stents remained patent. The occurrence of significant restenosis is low (3%), and these restenoses can be redilated and/or restented. Repeat dilation of the Palmaz stent implanted in branch pulmonary artery stenosis can be performed with safety and efficacy (94% success rate) up to 3 years after stent implantation.
血管内（帕尔马兹）支架已成功植入先天性和后天性分支肺动脉狭窄患者体内。早期结果非常好；然而，关于先天性心脏病患者再狭窄和重复扩张的情况尚无相关信息。本研究的目的是回顾再狭窄的发生率，并证明在这组患者中重复扩张支架的安全性和有效性。
在这项单中心研究的94例植入163个支架的患者中，43例植入73个支架的患者接受了再次导管检查。在73个再次研究的支架中，只有2个（3%）出现了明显的再狭窄。20例患者的30个支架进行了再次扩张。在支架植入时，该亚组患者的平均年龄为14.2岁，平均管腔直径从4.9毫米增加到10.7毫米（P = .0001），支架两端的收缩期压差（平均值）从52毫米汞柱降至11毫米汞柱（P = .0001）。再次导管检查时（平均13个月），所有支架均保持通畅。平均直径减小了1.2毫米（P = .0001），但压差的增加（平均3毫米汞柱）不显著（P = .11）。再次扩张后，直径从9.5毫米增加到12.2毫米（P = .0001），压差从14毫米汞柱降至8毫米汞柱（P = .0003）。2个出现再狭窄的支架成功进行了再次扩张。2例患者在18个月和26个月时对3个支架成功进行了第二次再次扩张。无并发症发生。
所有支架均保持通畅。明显再狭窄的发生率较低（3%），这些再狭窄可以再次扩张和/或重新植入支架。植入分支肺动脉狭窄处的帕尔马兹支架在植入后长达3年可安全有效地进行重复扩张（成功率94%）。
