Large-Bore Nitinol Stents for Malignant Superior Vena Cava Syndrome: Factors Influencing Outcome
Large-Bore Nitinol Stents for Malignant Superior Vena Cava Syndrome: Factors Influencing Outcome
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DOI：
10.2214/ajr.12.9582
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发表时间：
2013-09-01
影响因子：
5
通讯作者：
Nackaerts, Kristiaan
中科院分区：
文献类型：
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作者：
Maleux, Geert;Gillardin, Patrick;Nackaerts, Kristiaan
OBJECTIVE.本文旨在回顾性评价大口径镍钛合金支架治疗恶性上级腔静脉综合征的技术和临床结局。此外，我们分析了可能影响结果的因素。在7年的时间里，连续78名患者出现与原发性肺肿瘤（n = 62）或恶性淋巴结病（n = 16）相关的上级腔静脉综合征。分析的因素包括入院时的Kishi评分、肿瘤类型和是否需要额外的球囊扩张支架。除1例患者（99%）外，所有患者均获得了技术成功，该患者在插入后立即出现支架移位。在17例患者（22%）中，需要额外的球囊扩张支架来完全扩张镍钛合金支架。对于有症状的恶性淋巴结病或原发性肺肿瘤患者，6个月时的总生存率分别为50%（n = 8）和54%（n = 34），12个月时分别为19%（n = 3）和34%（n = 21）（p = 0.376）。Kishi评分（p = 0.80）或额外球囊扩张支架置入（p = 0.35）的生存率无差异。最后，在使用（n = 1）和未使用（n = 7）球囊扩张支架的患者中均观察到再闭塞事件。大口径镍钛合金支架对恶性上级腔静脉综合征非常有效。原发性肿瘤或继发性腺病引起的腔静脉狭窄患者的生存率相同。由于镍钛合金支架扩张不完全，22%的病例需要额外的球囊扩张支架，但与血栓形成率较高无关。
OBJECTIVE. The purpose of this article is to retrospectively evaluate the technical and clinical outcomes of large-bore nitinol stents for treating malignant superior vena cava syndrome. In addition, we analyzed factors potentially influencing the outcome.MATERIALS AND METHODS. Over a 7-year period, 78 consecutive patients presented with superior vena cava syndrome related to primary lung tumor (n = 62) or malignant lymphadenopathies (n = 16). The factors analyzed were Kishi score at admission, tumor type, and need for an additional balloon-expandable stent.RESULTS. Technical success was obtained in all but one patient (99%), who presented with a stent migration immediately after insertion. In 17 patients (22%), an additional balloon-expandable stent was needed for complete expansion of the nitinol stent. For patients with symptomatic malignant lymphadenopathies or primary lung tumor, overall survival rates were 50% (n = 8) and 54% (n = 34), respectively, at 6 months and 19% (n = 3) and 34% (n = 21), respectively, at 12 months (p = 0.376). There was no difference in survival as a function of the Kishi score (p = 0.80) or of the placement of an additional balloon-expandable stent (p = 0.35). Finally, reocclusion events were noted in patients both with (n = 1) and without (n = 7) a balloon-expandable stent.CONCLUSION. Large-bore nitinol stents are highly effective for malignant superior vena cava syndrome. The survival rates of patients with caval vein stenosis due to either the primary tumor or secondary enlarged adenopathies were equal. An additional balloon-expandable stent was required in 22% of cases owing to incomplete expansion of the nitinol stent but was not associated with higher thrombosis rate.