Balloon angioplasty with stent implantation in experimental coarctation of the aorta.
Balloon angioplasty with stent implantation in experimental coarctation of the aorta.
复制标题
球囊血管成形术与支架植入术治疗实验性主动脉缩窄。
DOI：
10.1161/01.cir.89.6.2677
复制
发表时间：
1994
期刊：
影响因子：
37.8
通讯作者：
C. E. Mullins
中科院分区：
文献类型：
--
作者：
W. Morrow;Vernon C. Smith;William J. Ehler;Adrian F. Vandellen;C. E. Mullins
背景
主动脉缩窄的球囊血管成形术是一种有效的治疗方法，但由于主动脉内膜撕裂、动脉瘤形成和再狭窄而变得复杂。球囊扩张时放置支架可以防止再狭窄，还可以防止内膜撕裂进展为动脉瘤。本研究的目的是评估在缩窄实验模型中球囊扩张和植入球囊扩张支架的可行性，并检查支架放置在手术造成的狭窄部位的效果。
方法和结果
对 11 只幼年猪进行了主动脉缩窄手术。手术后 34 +/- 7.8 天对 10 只动物同时进行缩窄血管成形术和支架植入术。支架植入后 59 +/- 6 天进行重复导管插入术。五只动物接受了支架再扩张并随后进行了导管插入术。通过光学显微镜和扫描电子显微镜检查主动脉标本。支架植入的缩窄血管成形术全部成功，缩窄直径从近端主动脉直径的 46 +/- 8.5% 增加到 90 +/- 12.2% (P = .0001)。收缩压梯度从 32 +/- 19.8 降至 0.5 +/- 2.8 mm Hg (P < .001)。所有支架在后续导管插入时均处于通畅状态，没有管腔内血栓形成的证据。五只动物的再扩张使支架直径从近端主动脉直径的平均 77.4 +/- 12.1% 增加到 93 +/- 11.0% (P = .02)。主动脉标本的肉眼检查表明，在支架支柱与主动脉壁接触的地方，在支架上形成了新内膜。支架占据内膜下位置并对下面的介质产生最小的压缩。在支架支柱下方立即观察到内侧压缩，但没有内膜或内侧剥离的证据。
结论
球囊血管成形术同时植入球囊扩张支架可有效缓解实验性缩窄的主动脉阻塞。刚性支架的再扩张可以在主动脉切开术和缩窄手术区域进行，而不会造成明显的内膜或内侧损伤。支架植入可用于预防缩窄血管成形术后的再狭窄和动脉瘤形成。
BACKGROUND
Balloon angioplasty of coarctation of the aorta is an effective method of treatment but is complicated by tearing of the aortic intima, formation of aneurysms, and restenosis. Stent placement at the time of balloon dilation could prevent restenosis and could also prevent progression of intimal tears to aneurysms. The purpose of this study was to evaluate the feasibility of balloon dilation and implantation of balloon-expandable stents in an experimental model of coarctation and to examine the effect of stent placement at the site of surgically created stenosis.
METHODS AND RESULTS
Coarctation of the aorta was surgically produced in 11 juvenile swine. Simultaneous coarctation angioplasty and stent implantation was performed in 10 animals 34 +/- 7.8 days after surgery. Repeat catheterization was performed 59 +/- 6 days after stent implantation. Five animals underwent reexpansion of stents with subsequent follow-up catheterization. Aortic specimens were examined by light microscopy and scanning electron microscopy. Coarctation angioplasty with stent implantation was successful in all, with an increase in coarctation diameter from 46 +/- 8.5% to 90 +/- 12.2% of proximal aortic diameter (P = .0001). Systolic pressure gradient decreased from 32 +/- 19.8 to 0.5 +/- 2.8 mm Hg (P < .001). All stents were patent at follow-up catheterization, with no evidence of intraluminal thrombosis. Reexpansion in five animals increased the stent diameter from a mean of 77.4 +/- 12.1% to 93 +/- 11.0% of proximal aortic diameter (P = .02). Gross examination of aortic specimens demonstrated formation of neointima over the stent wherever the stent struts were in contact with the aortic wall. The stent occupied a subintimal position and produced minimal compression of the underlying media. Medial compression was noted immediately beneath stent struts, but there was no evidence of intimal or medial dissection.
CONCLUSIONS
Balloon angioplasty with simultaneous implantation of balloon-expandable stents is effective in relieving aortic obstruction in experimental coarctation. Reexpansion of the rigid stent can be performed in an area of surgical aortotomy and coarctation without significant intimal or medial injury. Stent implantation may be useful in preventing restenosis and aneurysm formation after angioplasty of coarctation.