Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease.
Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease.
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DOI：
10.1016/s0735-1097(99)00644-0
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发表时间：
2000-03
影响因子：
24
通讯作者：
Yiu-fai Cheung;S. Sanatani;Maurice P. Leung;Derek G. Human;A. Chau;J.A.Gordan Culham
中科院分区：
文献类型：
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作者：
Yiu-fai Cheung;S. Sanatani;Maurice P. Leung;Derek G. Human;A. Chau;J.A.Gordan Culham
我们报告的早期和中期随访结果的自膨式Wallstent（施耐德，瑞士）植入儿童先天性心脏病。EQUEROUNDThe固有的缺陷，球囊扩张支架促使试验的替代stent.METHODSTwenty患者进行了22个自膨式Wallstents 1993年12月和1997年6月之间在两个机构。平均年龄和体重分别为10.8 ± 4.5岁和30.5 ± 14.2 kg。患者分为两组：1）I组包括17例肺动脉狭窄患者，2）II组包括4例静脉狭窄患者（1例属于两组）。16例患者在支架植入术后中位5.8个月（范围0.5 - 31，平均8.1个月）接受了再导管术。记录介入治疗后血流动力学和血管造影的变化及并发症。在第I组中，植入支架的血管的最西端直径从4.1 ± 1.5 mm增加到8 ± 2 mm（增加95%，p < 0.0001），而收缩压差从24.6 ± 15.8 mm Hg降低到12.1 ± 11.4 mm Hg（降低51%，p = 0.001）。在第II组中，最西段的尺寸变化从4.3 ± 0.5 mm增加到7.5 ± 0.4 mm（增加75%，p = 0.003），跨支架静脉通道的压力梯度从5.0 ± 2.9 mm Hg降低到0.9 ± 1.0 mm Hg（降低82%，p = 0.04）。两个最佳定位支架的远端迁移发生在植入后24小时内。在再导管插入术时，在7/25枚植入支架（28%）中观察到显著的新生内膜向内生长（>扩张直径的30%）。这对球囊扩张反应较差。结论自膨式Wallstent可安全、简便地应用于小儿血管狭窄的治疗，支架直径小于9mm，支架植入时间较长是新生内膜生长的易患因素。远端移位、显著新生内膜向内生长的并发症及其过度扩张的不屈服设计限制了其在该患者组的应用。
OBJECTIVESWe report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease.BACKGROUNDThe inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent.METHODSTwenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8 ± 4.5 years and 30.5 ± 14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented.RESULTSAll the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1 ± 1.5 to 8 ± 2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6 ± 15.8 to 12.1 ± 11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3 ± 0.5 to 7.5 ± 0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0 ± 2.9 to 0.9 ± 1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (<9 mm) and longer period after implantation.CONCLUSIONSSelf-expanding Wallstent could be deployed easily and safely to relieve vascular stenoses in children. The complications of distal migration, significant neointimal ingrowth and its unyielding design to overdilation limit its application to this patient group.