CTA指导下行裸支架植入术治疗孤立性肠系膜上动脉夹层动脉瘤

Percutaneous endovascular reconstruction with bare -metal placement guided by CTA for isolated spontaneous dissection of the superior mesenteric artery

目的 探讨CT血管成像（CTA）对孤立性肠系膜上动脉夹层动脉瘤临床治疗策略制定的作用及其对介入治疗的指导价值.方法 3例通过CTA检查明确为肠系膜上动脉夹层动脉瘤,后在CTA指导下行裸支架载瘤动脉血管重建,单纯采用裸支架植入2例,采用裸支架联合弹簧圈栓塞1例；3例均于术后3个月复查CTA以评价介入治疗效果.结果 3例患者介入手术均获成功,无并发症发生.术后CTA提示,支架位置及贴壁性好,假腔闭塞,真腔无明显狭窄,血运正常.结论 CTA对孤立性肠系膜上动脉夹层动脉瘤临床治疗决策及指导介入治疗实施有重要作用,裸支架植入术是治疗孤立性肠系膜上动脉夹层安全、有效的方法.

Objective To evaluate the value of CT angiography （CTA） on the development of clinical treatment strategies and its effect on interventional therapy about isolated superior mesenteric artery dissection （ISMAD）. Methods Three ISMAD cases confirmed by CTA were all accepted the treatment of percutaneous endovascular reconstruction with bare - metal placement guided by CTA. Implantations were done with simple use of bare - metal stents in 2 cases, bare stent and coil embolization in 1 case. Furthermore, all the patients were reexamined by CTA in order to evaluate the effect of interventional treatment three months later. Results Interventional treatment was achieved successfully in all three patients without any complications. Reexamination of CTA showed proper position of stents and the stents attached to the vascular wall very well. Furthermore, false lumen occlusion appeared but without obvious stenosis in true lumen, and blood circulation was normal. Conclusion CTA plays an important role in the clinical treatment decisions and guidance of the interventional therapy of ISMAD. Bare stent implantation is a feasible and effective method of ISMAD.