小管冠状动脉支架再通:人类患者的首次经验,手术技术和结果。

IF 1.3 4区 医学 Q3 OPHTHALMOLOGY
Mohammad Javed Ali
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引用次数: 0

摘要

目的:探讨药物洗脱钴铬合金冠状动脉支架在广泛小管梗阻患者中的可行性。方法:对4例早期泪囊鼻腔吻合术失败的广泛小管梗阻患者的4个小管进行初步研究。所有患者术前均行泪道内窥镜检查以确定小管梗阻。随后行全长小管穿刺和泪囊球囊成形术,并行泪囊鼻腔吻合术。使用直径2mm(完全扩张时)、长度12mm的西罗莫司洗脱冠状动脉支架,安装在球囊导管上。在内镜引导下将球囊导管插入小管。将球囊扩张至12个大气压,并将其固定在锁定(弹簧伸出)位置。然后将球囊放气,安全地取出,并通过泪道内窥镜再次确认支架位置。使用泪内镜、鼻内镜、CT扫描和MRI成像对植入支架进行术后监测,以评估其稳定性、结局和并发症。结果:药物洗脱钴铬合金冠状动脉支架可顺利置入,并固定于小管内所需位置。环钻小管均匀扩张360度,管腔宽而均匀。术中,新置入环管腔的边缘和间隙片均匀分布在支架环之间的间隙中,不影响已扩张的管腔。ct -泪囊造影(DCG)和MRI提供了支架位置、成角和通过支架的染料传导的额外信息。6周时,2例小管再闭塞,1例部分再闭塞,1例通畅。术后过程提供了一些新的知识,有助于进一步改进手术。如果外科医生熟练使用泪管穿刺术和泪囊成形术,则手术学习曲线较浅。结论:药物洗脱钴铬合金冠状动脉支架可以在良好的静脉小管内精确部署和固定。该研究首次证实了人类小管阻塞患者的小管冠状动脉支架再通手术技术。尽管有一些令人沮丧的失败,但这项初步研究为预防或治疗技术奠定了基础,这些技术有可能在广泛的小管疾病中保持小管通畅。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Canalicular Coronary Stent Recanalization: First Experience in Human Patients, Surgical Techniques and Outcomes.

Purpose: To investigate the feasibility of implanting a drug-eluting cobalt-chromium alloy coronary stent in patients with extensive canalicular obstructions.

Methods: The pilot study was carried out in 4 canaliculi of 4 patients with extensive canalicular obstructions in a setting of earlier failed dacryocystorhinostomy. All patients underwent preoperative dacryoendoscopy to characterize the canalicular obstruction. This was followed by full-length canalicular trephination and balloon dacryoplasty along with a revision dacryocystorhinostomy. Sirolimus-eluting coronary stents of 2 mm in diameter (when fully expanded) and 12 mm in length, mounted on balloon catheters, were used. The balloon catheters were introduced into the canaliculi under endoscopy guidance. The stents were delivered following dilatation of the balloon to 12 atmospheres and secured in a locked (spring-out) position. The balloon was then deflated, securely removed, and the stent position was reconfirmed with a dacryoendoscopy. Postoperative monitoring of the implanted stent was performed using dacryoendoscopy, nasal endoscopy, CT scans, and MRI imaging to assess its stability, outcomes, and complications.

Results: The drug-eluting cobalt-chromium alloy coronary stents could be delivered and secured at a desired position within the canaliculi. The trephined canaliculi were uniformly dilated 360 degrees with a wide and uniform lumen. Intraoperatively, the edges and intervening patches of the freshly trephined canalicular lumen were uniformly distributed in spaces between the stent rings without any influence on the already expanded lumen. CT-dacryocystography (DCG) and MRI provided additional information on the stent position, angulation, and dye conductance through the stent. At 6 weeks, 2 of the canaliculi reoccluded, 1 partially reoccluded, and 1 was patent. The postoperative course provided several new learnings that would help further modify the procedure. The surgical learning curve is shallow if the surgeon is adept with canalicular trephination and balloon dacryoplasty techniques.

Conclusion: Drug-eluting cobalt-chromium alloy coronary stents can be precisely deployed and secured within a well-trephined canaliculus. The study is the first to demonstrate the surgical technique of canalicular coronary stent recanalization in human patients with canalicular obstructions. While there were some frustrating failures, this pilot study, nevertheless, lays the foundations of prophylactic or therapeutic techniques that have the potential to maintain canalicular patency in a wide range of canalicular disorders.

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来源期刊
CiteScore
2.50
自引率
10.00%
发文量
322
审稿时长
3-8 weeks
期刊介绍: Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.
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