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烟支架,以防止冠状动脉阻塞,用气球扩展在自扩展内的气球扩展

Alessandro Beneduce¹, Arif A Khokhar², Jonathan Curio³

¹Heart Valve Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

|June 16, 2025

概括

在回复通透导管大动脉植入 (TAVI) 过程中,烟支架可能会导致支架扭曲和不足扩张,这是由于与现有的相互作用造成的. 这可能会危及未来的冠状动脉入口,用于穿皮冠状动脉干预.

科学领域:

心血管干预心血管干预
医疗设备工程医疗设备工程
解剖学建模解剖学建模

背景情况:

冠状动脉阻塞 (CO) 是 redo-transcatheter 大动脉植入 (TAVI) 程序期间的一个重大风险.
失败的超环状自我扩张的跨导管大动脉 (TAVs) 特别与 redo-TAVI 中的 CO 相关.
高风险患者解剖学需要创新的解决方案来减轻CO.

研究的目的:

评估烟支架 (ChS) 在解剖学上具有挑战性的病例中对 redo-TAVI 的可行性和结果.
评估支架的性能和冠状动脉接入 (CA) 后冠状动脉接入 (CA) 的潜力.
研究TAV类型和植入深度对ChS结果的影响.

主要方法:

使用患者特定的3D打印解剖模型,基于TAVI前的CT扫描.
模拟的回复TAVI与烟支架 (SAPIEN 3 超级) 在在脉动流下扩展的TAV (ACURATE neo2,Evolut PRO) 中.
评估了支架扩张 (IVUS),扭曲 (微CT) 和冠状动脉进入PCI的可行性.

主要成果:

烟支架与TAV框架或大动脉壁的相互作用导致了显著的扭曲和扩张不足.
在Evolut PRO中,高的SAPIEN 3超级植入深度导致了最大的不扩张 (压缩) 和垂直扭曲 (高达75°).
索引TAV的严重指针错位导致了实质性的侧向支架扭曲 (高达53°).
综合因素 (错位和高植入深度) 在75%的病例中使冠状动脉接入和PCI无法实现.

结论:

在用SAPIEN 3 Ultra进行 redo-TAVI 的过程中,烟支架容易发生支架变形和扩张不足.
冠状动脉支架与退化的TAV框架或大动脉壁之间的相互作用构成风险.
这些并发症可能会阻碍程序的成功,并危及PCI的未来冠状动脉接入.

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