急性B型主动脉夹层Castor单分支支架置入术后近端主动脉的早期重塑

Early remodeling of the proximal aorta after Castor single-branched stent-graft implantation for acute type B aortic dissection

目的评估急性B型主动脉夹层Castor单分支支架置入术后近端主动脉的早期重塑。方法收集2018年1月至2021年12月22例急性B型主动脉夹层因近端着陆区不足行Castor单分支支架置入术患者的临床数据。分析人口统计学特征、手术细节、术后并发症以及随访结果。通过计算机断层血管成像软件建立的三维图像测量主动脉角度、横截面积、长度和弯曲度等不同参数。比较术前和术后3个月近端主动脉的几何参数。结果与术前相比,术后主动脉弓与升、降主动脉以及左锁骨下动脉的夹角增大(P<0.001);术后升主动脉、近端主动脉弓的横截面积减小(P<0.05),总胸主动脉和假腔的横截面积减少(P<0.001),真腔的横截面积增加(P<0.001);术后主动脉弓长度增加(P<0.05),其他主动脉参数的变化差异无统计学意义(P>0.05)。结论Castor单分支支架治疗急性B型主动脉夹层术后对近端主动脉有良好的几何重塑作用,尤其为近端着陆区不良的患者提供了一种安全有效的治疗方法。

Objective To evaluate the early remodeling of proximal aorta after Castor single-branched stent-graft implantation for acute type B aortic dissection.Methods Clinical data of 22 patients with acute type B aortic dissection who underwent Castor single-branched stent-graft implantation due to unfavorable proximal landing zone during Jan.2018 and Dec.2021 were collected,including the demographic characteristics,surgical details,postoperative complications and follow-up results.Three-dimensional imaging created by computed tomography angiography was used to measure parameters such as angulation,cross-sectional area(CSA),length and tortuosity.The geometric parameters of the proximal aorta before operation and 3 months after operation were compared.Results After operation,the angle between aortic arch and ascending aorta,descending aorta and left subclavian artery increased(P<0.001),the cross-sectional areas of ascending aorta and the proximal aortic arch decreased(P<0.05),the cross-sectional areas of total thoracic aorta and false lumen decreased(P<0.001),the cross-sectional areas of the true lumen increased(P<0.001),and the length of aortic arch increased(P<0.05).There were no significant differences in the other aortic parameters(P>0.05).Conclusion Castor single-branched stent-graft has a good geometric remodeling effect on the proximal aorta after the treatment of acute type B aortic dissection,which provides a safe and effective treatment for patients with unfavorable proximal landing zone.