覆膜CP支架治疗主动脉缩窄的临床应用研究

Application of covered cheatham-platinum stent implantation with coarctation of aorta

目的:探讨覆膜(cheatham-platinum,CP)支架治疗青少年及成人先天性主动脉缩窄的临床应用价值。方法:回顾性分析2005年4月至2012年6月期间,接受CP支架介入治疗的23例主动脉缩窄患者,男性17例、女性6例,年龄12～29岁,平均(19.79±5.16)岁,体质量36～65 kg,平均(52.74±8.33)kg。患者术前经主动脉CTA检查,主动脉缩窄段平均直径4.2～11.7 mm,平均(6.53±1.89)mm,缩窄段长度5～23 mm,平均(14.63±4.64)mm。由股动脉穿刺入路置入装有支架的球囊导管,确切定位后扩张(balloon in balloon,BIB)球囊释放CP支架。结果:23例主动脉缩窄患者CP支架均成功置入,2例患者合并动脉导管未闭。术前缩窄段平均收缩压力阶差(63.8±17.6)mmHg(1 mmHg=0.133 kPa),术后缩窄段平均收缩压力阶差降至(6.47±2.12)mmHg;术后主动脉缩窄段直径增至(21.78±3.19)mm。随访3～12个月,除2例患者术后需继续控制血压外,余患者无上下肢压力阶差及高血压表现。复查CT示缩窄段管腔未发生再狭窄及其它并发症。结论:CP支架对治疗青少年及成人主动脉缩窄的近期疗效满意,远期效果有待进一步观察。

Objective：To evaluate the outcome of covered Cheatham-Platinum（CP）stent implantation for the treatment of native coarctation of Aorta（COA）.Methods： From August 2005 to June 2012,23 patients（17 male and 6 female）with native COA who were diagnosed by computed tomography angiography accepted the treatment of covered CP stent implantation.The mean age was（19.79±5.16） years,the mean weight was 36-65 kg,（52.74±8.33） kg,the mean coarctation diameter was 4.2-11.7 mm,（6.53±1.89）mm,and the mean coarctation length was 5-23 mm,aveiage was（14.63±4.64） mm,measured by aortic computed tomography angiography.The size of stent and balloon were chosen according to digital subtraction angiography（DSA） examinations.The covered CP stent was delivered to the lesion by the balloon and catheter delivery system,and was released by expanding the balloon.Follow-up was comprised of monitoring of blood pressure and CTA.Results：Interventional procedures were successful in all cases without any major adverse events.Significant reduction of systolic blood pressure was observed after the procedure pre-stent（63.8±17.6） mmHg,post-stent（6.47±2.12） mmHg except 2 cases.The mean COA diameter increased from（6.53±1.89） to（21.78±3.19） mm.It had been observed that two adult-type coarctation patients associated with patent ductus arteriosis had no persistent left-to-right shunt after covered Cheatham-Platinum stent implantation.The follow up range was from 3 to 12 months.During follow-up,two patients with sustained hypertension needed to be treated with medication control and no retraction was observed on computed tomography.All patients had released symptoms and better hypertension control.Conclusion：The short-term effect that covered Cheatham-Platinum stent implantation in adolescent and adult with native coarctation of aorta is satisfactory.Also,the long-term effect needs further observation.