Balloon-expandable stent treatment of experimental coarctation of the aorta: early hemodynamic and pathological evaluation.
Balloon-expandable stent treatment of experimental coarctation of the aorta: early hemodynamic and pathological evaluation.
复制标题
球囊扩张支架治疗实验性主动脉缩窄：早期血流动力学和病理学评估。
DOI：
10.1111/j.1540-8183.1993.tb00843.x
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发表时间：
1993
影响因子：
2.1
通讯作者：
F. Lupinetti
中科院分区：
文献类型：
--
作者：
R. Beekman;D. Muller;P. Reynolds;C. Moorehead;K. Heidelberger;F. Lupinetti
本研究旨在评估实验性主动脉缩窄的球囊可扩张支架治疗的急性和短期血流动力学、血管造影和病理反应。对6只杂种狗（2只成年狗，4只幼犬）进行了离散性胸缩手术。术后2个月，所有6只狗（8.9-30公斤）通过股动脉切开进行左心导管置入和狭窄支架置入。Palmaz PS-30支架通过10 French鞘推进至缩窄，并选择与近端主动脉直径相等（9-12 mm）的血管成形术球囊进行扩张。每只狗的支架植入都很成功。收缩压梯度由26.3 +/- 9.1 mmHg（平均+/- SE）降至0.5 +/- 0.5 mmHg (P = 0.04)，缩窄直径由近端降主动脉直径的50 +/- 6%降至82 +/- 6% （P < 0.01）。支架置入术后4-7周的随访记录显示，无支架移位、早期再狭窄、血栓形成、动脉侧分支阻塞或动脉瘤形成。对支架主动脉移植段的病理评估表明，在6-7周时，支架被由内膜增生和纤维化组成的新内膜覆盖，表面有内皮细胞。这些数据表明，在这个实验模型中，球囊膨胀不锈钢支架提供了良好的急性和短期的收缩缓解。需要更大规模和更长期的研究来更好地评估主动脉狭窄支架置入后再狭窄或动脉瘤形成的发生率。
The present study was intended to evaluate the acute and short-term hemodynamic, angiographic, and pathological response to balloon-expandable stent treatment of experimental coarctation of the aorta. A discrete thoracic coarctation was surgically created in six mongrel dogs (two adults, four puppies). Two months postoperatively all six dogs (8.9-30 kg) underwent left heart catheterization and coarctation stenting performed through a femoral artery cutdown. A Palmaz PS-30 stent was advanced to the coarctation through a 10 French sheath, and expanded with an angioplasty balloon chosen to equal the diameter of the proximal aorta (9-12 mm). Stent implantation was successful in each dog. The systolic pressure gradient decreased from 26.3 +/- 9.1 mmHg (mean +/- SE) to 0.5 +/- 0.5 mmHg (P = 0.04), and the coarctation diameter improved from 50 +/- 6% to 82 +/- 6% of the diameter of the proximal descending aorta (P less than 0.01). Follow-up catheterization 4-7 weeks after stenting documented no stent migration, early restenosis, thrombosis, obstruction of arterial side branches, or aneurysm formation. Pathological evaluation of the explanted segments of stented aorta documented that by 6-7 weeks the stents are covered by a neointima composed of intimal proliferation and fibrosis with an endothelial cell surface. These data suggest that balloon-expandable stainless steel stents provide excellent acute and short-term relief of coarctation in this experimental model. Larger and longer-term studies are needed to better assess the incidence of restenosis or aneurysm formation following stenting of coarctation of the aorta.