新一代单层 PTFE 包覆冠状动脉支架用于非冠状动脉病变中先天性动脉侧支损伤的血管内修复,RECOVER(使用 COVERed 支架经皮介入治疗后的结果)研究者。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Revascularization Medicine Pub Date : 2024-10-18 DOI:10.1016/j.carrev.2024.09.018
Lisa Strauß, Lorenzo Gibello, Felix Voll, Hector A Alvarez-Covarrubias, Tobias Lenz, Salvatore Cassese, Erion Xhepa, Michael Joner, Heribert Schunkert, Adnan Kastrati, Maria Antonella Ruffino, Sebastian Kufner
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引用次数: 0

摘要

背景:由于经皮介入治疗各种心血管疾病的机会越来越多,外周动脉先天性损伤的发生率也在不断上升。因此,在血管损伤后植入覆盖支架(CS)进行血管内修复,作为开刀手术的替代方法正变得越来越重要。在较小的侧支损伤病例中,先对主血管进行支架植入,然后再对侧支进行切除和封堵,这与不利的血管再通率和相应供血区域不可预测的缺血性并发症有关:本研究报告了先天性血管侧支损伤患者直接在损伤部位接受冠状动脉造影术治疗的过程和临床结果:这是一项回顾性、多中心登记研究,包括 40 名动脉侧支急性先天性损伤患者,他们于 2014 年 6 月至 2023 年 6 月期间在欧洲 3 个不同中心接受了单层聚四氟乙烯(PTFE)-CS 植入术。终点是手术成功率、死亡、靶血管再介入(TVR)、出血和手术转换需求:共有 40 名患者在下肢(97.5%)和上肢(2.5%)接受了单层 PTFE-CS 植入术。最常见的机制是穿刺损伤,由针头和/或鞘造成(80%)、球囊扩张(7.5%)和非心脏手术期间/之后(7.5%)。所有病例都取得了手术成功(100%)。院内死亡率为 7.5%。CS手术后的中位住院时间为4天[2; 5.3]。中位随访时间为202.5天[97.3-711.8天],36名患者(90%)存活,主血管通畅率为100%。没有发生 TVR、出血或手术转换。在所有病例中,5%的患者出现了与入路相关的并发症:在这项研究中,在先天性动脉损伤后的非冠状动脉侧支病变中使用新一代单层聚四氟乙烯覆盖冠状动脉支架显示出较高的技术成功率以及良好的临床疗效和安全性。
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New-generation single-layer PTFE-covered coronary stent for endovascular repair of iatrogenic arterial side-branch injury in non-coronary lesions for the RECOVER (REsults after percutaneous interventions with COVERed stents) Investigators.

Background: The incidence of iatrogenic injuries in peripheral arteries is increasing due to the expanding opportunities of managing various cardiovascular diseases by means of percutaneous intervention. Thus, endovascular repair with implantation of covered stent (CS) after vascular injury is gaining importance as an alternative to open surgery. In cases of smaller side-branch injuries, stenting of the main vessel with subsequent exclusion and sealing of the side-branch is associated with unfavourable revascularization rates and unpredictable ischemic complications in the corresponding supply area.

Objective: This study reports the procedural and clinical outcomes of patients with iatrogenic vascular side-branch injuries treated with coronary-CS directly at the site of injury.

Methods: This is a retrospective, multicentre registry study, including 40 patients with acute iatrogenic injuries of arterial side-branches undergoing implantation of single-layer polytetrafluorethylene (PTFE)-CS at 3 different centres in Europe between June 2014 and June 2023. Endpoints were procedural success, death, target vessel reintervention (TVR), bleeding and the need for surgical conversion.

Results: A total of 40 patients underwent implantation of single-layer PTFE-CS in the lower (97.5 %) and the upper limbs (2.5 %). The most common mechanisms were injuries after punctures, caused by needle and/or sheath (80 %), balloon-dilations (7.5 %) and during/after non-cardiac surgery (7.5 %). Procedural success was achieved in all cases (100 %). The rate of in-hospital mortality was 7.5 %. The median duration of hospitalization after the CS procedure was 4 days [2; 5.3]. At a median follow-up of 202.5 days [97.3-711.8], 36 patients (90 %) were alive and main vessel patency was 100 %. There were no cases of TVRs, bleedings or surgical conversions. Access-site related complications occurred in 5 % of all cases.

Conclusions: In this study, the use of new-generation single-layer PTFE-covered coronary stents in non-coronary side-branch lesions after iatrogenic arterial injury shows a high technical success rate and favourable clinical efficacy and safety.

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来源期刊
Cardiovascular Revascularization Medicine
Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.90%
发文量
687
审稿时长
36 days
期刊介绍: Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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