Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction
Comparison of Covered Versus Uncovered Stents for Benign Superior Vena Cava (SVC) Obstruction
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DOI：
10.1007/s00270-018-1906-3
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发表时间：
2018-05-01
影响因子：
2.9
通讯作者：
Bjarnason, Haraldur
中科院分区：
文献类型：
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作者：
Haddad, Mustafa M.;Simmons, Benjamin;Bjarnason, Haraldur
为了确定使用覆膜支架与未覆膜支架治疗良性SVC梗阻的长期症状缓解和支架通畅性是否不同，我们回顾性地确定了2003年1月至2015年12月期间接受支架置入治疗的所有良性SVC综合征患者（n = 59）。仅纳入了临床和影像学随访病例（n = 47）。在33例（70%）患者中，梗阻是由于中心导管或起搏器导线，14例（30%）患者的原因是纤维化纵隔炎。17例（36%）患者植入覆膜支架，30例（64%）患者植入未覆膜支架。评价了临床和治疗结果、并发症和每种支架的狭窄百分比。所有病例在首次尝试时均获得了技术成功。平均临床和影像学随访年数分别为2.7（范围0.1-11.1）（覆盖）和1.7（范围0.2-10.5）（未覆盖）。覆盖组（5/17或29.4%）和未覆盖组（18/30或60%）报告症状复发的患者数量存在显著差异（p = 0.044）。覆膜组[17.9%（范围0-100）+/- 26.2]和未覆膜组[48.3%（范围6.8-100）+/- 33.5]支架置入后的平均狭窄百分比也存在显著差异（p = < 0.001）。手术日期与报告症状复发的临床随访日期之间的时间（天）无显著差异（p = 0.227）[覆盖：426.6（范围28-1554）+/- 633.9和未覆盖778.1（范围23-3851）+/- 1066.8]。未覆盖组中有1例患者接受了非血管内外科手术干预（无名右心房旁路术），而覆盖组中无患者需要外科手术干预。发生了1例重大并发症（SIR C级），包括血管成形术后心包出血性积液，需要置入覆膜支架。无手术相关死亡，覆膜支架和非覆膜支架均可用于治疗良性SVC综合征。然而，如果通过进一步研究验证，覆膜支架可能是缓解症状和维持支架通畅性的更有效选择。
To identify whether long-term symptom relief and stent patency vary with the use of covered versus uncovered stents for the treatment of benign SVC obstruction.We retrospectively identified all patients with benign SVC syndrome treated to stent placement between January 2003 and December 2015 (n = 59). Only cases with both clinical and imaging follow-up were included (n = 47). In 33 (70%) of the patients, the obstruction was due to a central line or pacemaker wires, and in 14 (30%), the cause was fibrosing mediastinitis. Covered stents were placed in 17 (36%) of the patients, and 30 (64%) patients had an uncovered stent. Clinical and treatment outcomes, complications, and the percent stenosis of each stent were evaluated.Technical success was achieved in all cases at first attempt. Average clinical and imaging follow-up in years was 2.7 (range 0.1-11.1) (covered) and 1.7 (range 0.2-10.5) (uncovered), respectively. There was a significant difference (p = 0.044) in the number of patients who reported a return of symptoms between the covered (5/17 or 29.4%) and uncovered (18/30 or 60%) groups. There was also a significant difference (p = < 0.001) in the mean percent stenosis after stent placement between the covered [17.9% (range 0-100) +/- 26.2] and uncovered [48.3% (range 6.8-100) +/- 33.5] groups. No significant difference (p = 0.227) was found in the time (days) between the date of the procedure and the date of clinical follow-up where a return of symptoms was reported [covered: 426.6 (range 28-1554) +/- 633.9 and uncovered 778.1 (range 23-3851) +/- 1066.8]. One patient in the uncovered group had non-endovascular surgical intervention (innominate to right atrial bypass), while none in the covered group required surgical intervention. One major complication (SIR grade C) occurred that consisted of a pericardial hemorrhagic effusion after angioplasty that required covered stent placement. There were no procedure-related deaths.Both covered and uncovered stents can be used for treating benign SVC syndrome. Covered stents, however, may be a more effective option at providing symptom relief and maintaining stent patency if validated by further studies.