Middle aortic syndrome caused by Takayasu's disease and treated by stent implantation: a report of medium-term follow-up

A 13-year-old girl with middle aortic syndrome caused by Takayasu's disease was treated by balloon angioplasty of the right renal artery stenosis and the implantation of 3 stents, 2 in the stenosed thoracic segment and 1 in the abdominal segment of the aorta. Spiral computed tomography one and two years after the stents were inserted showed that the disease had progressed despite treatment with immunosuppressants.     

Transcatheter double stent implantation for treatment of middle aortic coarctation syndrome

A 13‐year‐old boy presented with severe systemic hypertension. His upper limb blood pressure measured 190/100 mm Hg and lower limb blood pressure measured 98/64 mm Hg. The brachial pulses were bounding and femoral pulses were not palpable. Echocardiography and magnetic resonance angiography confirmed middle aortic syndrome. There was severe diffuse thoraco‐abdominal coarctation with continuous Doppler run‐off. Cardiac catheterization was undertaken and using a retrograde approach two Advanta V12 stents were implanted in the complex thoraco‐abdominal coarctation. The gradient across the coarctation was reduced from 80 to 40 mm Hg gradient with a significant improvement in the luminal diameter of the aorta. His upper limb blood pressure reduced to 142/78 mm Hg six weeks later. © 2013 Wiley Periodicals, Inc.     

覆膜血管支架治疗外伤性主动脉破裂

目的:总结利用覆膜血管支架治疗主动脉外伤的经验和体会。方法:2008年5月至2011年2月,完成覆膜血管支架,治疗外伤后主动脉破裂16例,其中男性12例,女性4例;年龄22～77岁,平均(43.2±23.5)岁,体质量43～92 kg,平均(71±16)kg;10例为Stanford B型主动脉夹层动脉瘤,6例为降主动脉假性动脉瘤形成。结果:全组无围术期死亡,无脊髓损伤、肢体缺血、支架移位及急性脑缺血等严重并发症。术后住院7～25 d,术后3个月,复查胸主动脉CT血管造影(CTA)示原发破口封闭满意,支架位置良好。结论:覆膜血管支架置入术,是治疗外伤性主动脉破裂的可靠方法,若适应证明确,可替代传统开胸手术治疗。     

Direct stent implantation in acute coronary syndrome

OBJECTIVE: To evaluate the feasibility and safety of direct stenting and to compare it with conventional implantation techniques in patients with acute coronary syndrome (ACS). METHODS: A total of 145 patients were divided into two arms based on the stenting technique used: group I (n = 71) = direct stenting without predilatation group that included only single-vessel procedures and group II (n = 74) = stenting with predilatation group that included only single-vessel conventional stent implantations. The primary endpoint of the study was the major adverse clinical event (MACE) rate in-hospital, at 1 month, and at 6 months and the secondary endpoint was the balloon inflation time (BIT), the number of balloon inflations (NBI), the radiation exposure time (RET), the amount of contrast dye used (ACD) and the no-reflow phenomenon. RESULTS: Primary success rate was 89% in group I and 95% in group II; overall procedural success rate was 94% in group I and 100% in group II. The rate of MACE was not different during the follow-up period between the two groups. The RET, BIT and NBI were significantly lower in group I than in group II (p < 0.001 for all). The ACD used was also significantly lower in group I than in group II (125 60 ml versus 155 71 ml; p = 0.006). Furthermore, the rate of no-reflow was significantly lower in group I than in group II (2.8% versus 13.5%; p = 0.03). CONCLUSION: Direct stenting is a feasible and safe technique. It is equivalent to single-vessel conventional stent implantation techniques with respect to MACE rate in-hospital, at 1 month, and at 6 month follow-up in selected patients with ACS.     

Primary stent implantation in aortic coarctation: mid-term follow-up

BACKGROUND: The use of balloon-expandable stents provides an effective alternative therapy in patients with stenotic lesions in congenital heart disease. Stents implantation has served to improve the results and to reduce complications of balloon angioplasty for coarctation and recoarctation of the aorta. OBJECTIVE: We report our results after primary stents implantation for coarctation and recoarctation of the aorta. PATIENTS AND METHODS: Balloon-expandable stents were implanted in 14 patients (mean age 20 +/- 12 years) with coarctation of the aorta (11 native and 3 postoperative); 2 patients had associated malformations. The morphology varied: 10 resembled a located-diaphragm (one of them with moderate arch hypoplasia); 2 had distorted coarctation and 2 had a complete aortal obstruction. Five patients were hypertensive and 1 had cardiogenic shock and severe arrhythmias which did not respond to intensive medical therapy. In all cases 14 Palmaz stents (7 P308 and 7 P4014) were implanted with the primary technique through a Mullin's sheath. The balloon-to-descending aorta diameter ratio, measured at the level of the diaphragm, was 1. A special technique was carried out in the 2 cases with complete aortal obstruction. RESULTS: The procedure was effective in all 14 cases. The coarctation diameter increased from 4 +/- 2 to 15 +/- 2 mm (p < 0.0001) and transcoarctation systolic pressure gradient decreased from 43 +/- 19 to 2 +/- 2 mmHg (p < 0.0001). The ratio of the coarctation to descending aorta diameter measured at the level of the diaphragma increased from 0.3 +/- 0.1 to 0.95 +/- 0.05 (p < 0.001). At 19 +/- 8 months follow up, all patients showed sustained clinical improvement. The patient with complete aortal obstruction experienced a dramatic improvement, but she died from a sudden cardiac event 22 months after the procedure. At angiographic follow up in 7 patients, 1 year after implantation, no recoarctation was observed with secondary vessels patent, and absence of restenosis. CONCLUSIONS: a) Percutaneous endovascular stents implantation in coarctation and recoarctation of the aorta may become an effective treatment modality in the older child, adolescent and adults; b) stents are particularly attractive in those patients with a more complex anatomy and higher surgical risk; c) primary stenting is expected to have a lower rate of complications, and d) we describe a special technique with a right femoral-left humeral arterial circuit that is successfully applied to patients with complete aortal obstruction.     

Transcatheter stent implantation to treat aortic coarctation in infancy.

A ten week old girl who had previously undergone a palliative procedure for the hypoplastic left heart syndrome had unrelieved aortic coarctation that did not respond to standard balloon dilatation. Complete relief of coarctation with prompt clinical improvement was achieved with placement of an 8 mm self-expanding stent. Transcatheter stent implantation may have a role in selected patients with aortic coarctation.     

Severe aortic stenosis successfully treated with percutaneous aortic valve implantation]

Patients with severe calcific aortic stenosis are occasionally not amenable to surgery because of advanced age or severe co-morbidities. Percutaneous aortic valve dilation is used but has only limited time relief. While preclinical evidence on percutaneous aortic valve replacement seems promising, only very limited clinical data are available worldwide. We hereby present the first case of percutaneous aortic valve replacement successfully performed in Italy in a 74-year-old high-risk female. This case emphasizes the technical challenges inherent to this procedure and its promising role in selected very high-risk patients with severe aortic stenosis, notwithstanding the early and long-term risk of adverse events.     

Long-term follow-up in patients treated by stent implantation for post-ablation pulmonary vein stenosis

Purpose

Symptomatic severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a rare but well-recognized complication. Treatment options include pulmonary vein angioplasty with or without drug eluting balloons or angioplasty with stent implantation. The treatment of choice is unclear. In our center, pulmonary vein stenting is the treatment of choice for significantly stenotic veins. We present the long-term clinical outcome of 9 patients treated with stent implantation.

Methods

Between 2001 and 2015, 3048 patients with AF were treated with catheter ablation at our institution, of which 9 developed symptomatic PVS. A total of 11 PVS were treated. Pre-procedural imaging (CT, MR, transesophageal echocardiography, angiography) was performed in all patients.

Results

Mean time from ablation to stenting was 18 months. Three patients had recurrent pneumonia and the remaining reduced functional capacity (NYHA 2). All patients were in functional capacity NYHA 1 (p?<?0.05) after a mean follow-up of 64 (18–132) months. Three patients still had paroxysmal AF, of which two have undergone repeated ablation.

Conclusions

Symptomatic PVS after AF ablation can be successfully treated by stent implantation with durable results and good clinical outcome. AF ablation is still a feasible option after stent deployment.

     

Spontaneous dissection of the left main coronary artery treated by multiple stent implantation

We report a case of spontaneous dissection of the left main coronary artery in a 32-year-old healthy woman that was unrelated with childbirth or other known risk factors. The clinical presentation was an extensive acute anterior myocardial infarction. She was treated by thrombolysis, but did not meet reperfusion criteria. Coronary angiography revealed dissection of the left main coronary artery that extended into the anterior descending and circumflex coronary arteries. Rescue angioplasty with stenting was performed. The clinical, diagnostic, and therapeutic features of this rare entity are discussed.     

Aneurysm formation following stent implantation for aortic coarctation detected by multidetector computed cardiac tomography

A 43-year-old hypertensive woman was referred for control ofher blood pressure became increasingly difficult, requiringmultiple agents. Physical examination showed a difference inblood pressure between both arms, systolic     

Successful RF ablation of permanent VT in a patient with acute coronary syndrome treated by complex angioplasty and stent implantation

We describe a case of a 59-year-old male with permanent VT in the course of an acute coronary syndrome. Coronary angiography revealed acute occlusion of the right coronary artery. Although the underlying condition was treated by implantation of 4 stents with excellent haemodynamic effect (TIMI 3), the tachycardia continued, being refractory to drugs (amiodarone). The attempts to restore sinus rhythm by DC electrical cardioversion or transvenous pacing were unsuccessful. The patient was referred to the EP lab. A critical isthmus localised at the paraseptal region of the LV and parallel to the mitral annulus was identified. The isthmus was closed by linear RF application, resulting in VT termination. Due to impaired LV ejection fraction (<30%) the patient was scheduled for ICD implantation. During 6-week follow-up the patient remained free of arrhythmia.     

Brachial plexus injury as an unusual complication after aortic stent implantation

Aorta catheterisation can serve both diagnostic and therapeutic purposes in patients with aortic coarctation, especially when non-invasive evaluation cannot define severity of the abnormality. We report a case of bilateral brachial plexus injury due to standard positioning of the patient's arms during non-complicated aorta catheterisation and aortic stent implantation under general anaesthesia. In discussion, we consider our patient's predisposing factors, the understanding of which may be helpful in avoiding this complication in the future.     

腹主动脉瘤支架置入术后处理

目的探讨腹主动脉瘤支架植入术后的处理方法,提高治疗效果,减少并发症的发生。方法收集我院自2011年4月至2014年2月收治的腹主动脉瘤患者38例,分为对照组和观察组,各19例。均采用支架置入术,术后对照组给予常规的护理治疗方式,观察组在常规护理治疗的基础上给予科学的康复干预处理。1个月后观察比较两组的疗效。结果对照组14例患者术后康复良好,康复率73.7%,4例患者出现较重并发症,1例患者病情加重死亡;观察组18例患者康复良好,康复率94.7%,1例出现较重并发症,无死亡病例。结论观察组患者康复率94.7%明显高于对照组康复率73.7%,并发症少于对照组,得出腹主动脉瘤支架置入术后,给予科学的康复干预处理,可以有效的提高患者康复率,减短康复时间,并发症少,值得临床推广和应用。     

经皮支架置入术治疗主动脉缩窄的疗效及安全性

目的　评估经皮支架置入术治疗主动脉缩窄的疗效。方法　 5例 [男性 3例 ,平均年龄(33± 9)岁 ]胸主动脉缩窄患者行经皮主动脉球囊成形术及支架置入术。结果　各例支架置入后即刻压力阶差显著减低为 (8± 2 )mmHg(1mmHg =0 133kPa) ,与术前 (73± 6 )mmHg比较 ,差异有显著性(P <0 0 0 1)。平均随访 (2 7± 12 )月 ,各例无需多种药物治疗但血压控制良好 ,收缩压平均为 (15 2± 7)mmHg ,舒张压 (91± 5 )mmHg ,与术前收缩压 (2 0 1± 8)mmHg、舒张压 (12 0± 8)mmHg比较 ,差异有显著性 (P <0 0 0 1) ,无不良事件发生。结论　经皮支架置入术治疗主动脉缩窄安全可行 ,且对患者血压控制具有长期疗效。     

Middle aortic syndrome: a case report

Middle aortic syndrome (MAS) results from a diffuse narrowing of the distal thoracic or abdominal aorta commonly involving both the visceral and renal arteries. Congenital, acquired, inflammatory, and infectious etiologies have been described. Symptoms typically occur within the first three decades of life and include hypertension, lower extremity claudication, and mesenteric ischemia. The condition is considered a life-threatening emergency as a result of the complications associated with severe hypertension. Diagnosis is made with magnetic resonance and computed tomography angiography. Surgical bypass grafting is the optimal method of treatment and must be tailored depending on the distribution of disease. We report one case of MAS treated with thoracic aorta to abdominal aorta bypass and reimplantation of the right renal artery.     

Initial and six-year results of stent implantation for aortic coarctation in children

Although stenting has been used as a treatment option for aortic coarctation (CoA) at increasingly younger ages, limited information is available on the long-term follow-up of stent implantation for CoA in pediatric patients. A total of 74 patients with CoA (mean age 8 ± 3 years) underwent stent implantation; 42 were treated for isolated native CoA and 32 for recurrent CoA. A total of 87 stents were implanted (bare metal stents in 71 patients and covered stents in 3 patients). Redilation of a previously implanted stent was performed in 32 patients. Immediately after stenting, the peak systolic pressure gradient decreased from 68 ± 16 mm Hg to 8 ± 5 mm Hg (p <0.05), and the CoA diameter increased from 5 ± 3 mm to 16 ± 3 mm (p <0.05). The most important procedural complication was aneurysm formation in 1 patient that was successfully treated with implantation of a covered stent. No early or late deaths occurred and no evidence was found of late aneurysm formation during a follow-up period of 6 years. Late stent fracture was observed in 3 patients. At the end of follow-up, no cases of recoarctation were identified on multislice computed tomography or magnetic resonance imaging, and 67 (85%) of the 74 patients were normotensive, receiving no medications. In conclusion, stent implantation is an effective and safe treatment alternative to conventional surgical management for the treatment of CoA in selected pediatric patients.     

B型主动脉夹层患者覆膜支架置入后围手术期护理

目的: 讨论DSA覆膜支架置入术治疗Standford B型主动脉夹层病人围手术期的护理方法。 方法 对我院2012年3月_2014年11月,明确诊断的15例Standford B型主动脉夹层的住院病人通过介入方法进行覆膜支架置入术治疗,并对围手术期的护理进行回顾性分析。结果 15 患者均痊愈出院。结论 主动脉腔内覆膜支架治疗Standford B型主动脉夹层临床效果满意,成功率高且安全有效,良好的围术期护理是疗效满意的重要保障。