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Article: Early and intermediate-term complications of self-expanding stents limits its potential application in children with congenital heart disease

TitleEarly and intermediate-term complications of self-expanding stents limits its potential application in children with congenital heart disease
Authors
Issue Date2000
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jac
Citation
Journal Of The American College Of Cardiology, 2000, v. 35 n. 4, p. 1007-1015 How to Cite?
AbstractOBJECTIVES. We report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease. BACKGROUND. The inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent. METHODS. Twenty 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. RESULTS. All the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stended 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 occured 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. CONCLUSIONS. Self-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. (C) 2000 by the American College of Cardiology.
Persistent Identifierhttp://hdl.handle.net/10722/170307
ISSN
2015 Impact Factor: 17.759
2015 SCImago Journal Rankings: 10.097
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, YFen_US
dc.contributor.authorSanatani, Sen_US
dc.contributor.authorLeung, MPen_US
dc.contributor.authorHuman, DGen_US
dc.contributor.authorChau, AKTen_US
dc.contributor.authorCulham, JAGen_US
dc.date.accessioned2012-10-30T06:07:23Z-
dc.date.available2012-10-30T06:07:23Z-
dc.date.issued2000en_US
dc.identifier.citationJournal Of The American College Of Cardiology, 2000, v. 35 n. 4, p. 1007-1015en_US
dc.identifier.issn0735-1097en_US
dc.identifier.urihttp://hdl.handle.net/10722/170307-
dc.description.abstractOBJECTIVES. We report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease. BACKGROUND. The inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent. METHODS. Twenty 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. RESULTS. All the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stended 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 occured 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. CONCLUSIONS. Self-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. (C) 2000 by the American College of Cardiology.en_US
dc.languageengen_US
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jacen_US
dc.relation.ispartofJournal of the American College of Cardiologyen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAngiographyen_US
dc.subject.meshAngioplasty, Balloon - Instrumentationen_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshConstriction, Pathologic - Radiography - Therapyen_US
dc.subject.meshEquipment Failure Analysisen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHeart Defects, Congenital - Radiography - Therapyen_US
dc.subject.meshHemodynamics - Physiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshProsthesis Designen_US
dc.subject.meshPulmonary Artery - Abnormalities - Radiographyen_US
dc.subject.meshPulmonary Veno-Occlusive Disease - Radiography - Therapyen_US
dc.subject.meshRetreatmenten_US
dc.subject.meshStentsen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleEarly and intermediate-term complications of self-expanding stents limits its potential application in children with congenital heart diseaseen_US
dc.typeArticleen_US
dc.identifier.emailCheung, YF:xfcheung@hku.hken_US
dc.identifier.authorityCheung, YF=rp00382en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/S0735-1097(99)00644-0en_US
dc.identifier.pmid10732902-
dc.identifier.scopuseid_2-s2.0-0034654131en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0034654131&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume35en_US
dc.identifier.issue4en_US
dc.identifier.spage1007en_US
dc.identifier.epage1015en_US
dc.identifier.isiWOS:000085917200025-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridCheung, YF=7202111067en_US
dc.identifier.scopusauthoridSanatani, S=6602739780en_US
dc.identifier.scopusauthoridLeung, MP=7201944800en_US
dc.identifier.scopusauthoridHuman, DG=7005601528en_US
dc.identifier.scopusauthoridChau, AKT=35787094400en_US
dc.identifier.scopusauthoridCulham, JAG=7005227194en_US

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