三维导航技术在Stanford B型主动脉夹层血管腔内隔绝术中的应用

Application of three-dimension navigation technology in endovascular stent-graft exclusion in the treatment of Stanford type B aortic dissection

目的探讨Inspace iPilot三维导航技术在血管腔内隔绝术（EVGE）治疗Stanford B型主动脉夹层中的临床价值及操作技巧。方法对6例Stanford B型胸主动脉夹层患者在三维导航技术下行EVGE,术前在升主动脉行旋转血管造影,将旋转采集图像传入工作站,重建主动脉三维图像。在工作站中从不同角度观察主动脉夹层图像,选择最佳工作角度。利用Inspace iPilot技术,在最佳工作角度下,将主动脉夹层三维图像的二维投照和实时透视相叠加。透视引导下置入支架释放系统,依据三维导航图像确定锚定部位,定位准确后释放覆膜支架,完成EVGE。结果 6例患者EVGE均获得成功,无左锁骨下动脉开口封闭、内漏等并发症发生。术后随访1~6个月,胸背部疼痛症状消失,无截瘫发生。结论 Inspace iPilot三维导航技术下EVGE治疗Stanford B型主动脉夹层精确度高,创伤小,疗效确切。

Objective To explore the clinical value and operating skills of three-dimensional（3D） navigation technology（Inspace iPilot） in treating Stanford type B aortic dissection（AD） with endovascular graft exclusion（EVGE）.Methods EVGE procedures were performed on 6 patients with Stanford type B AD under guidance of 3D navigation technology.Before the interventional operation,3D aortic images were reconstructed from rotational angiographic acquisitions,and ideal projections were chosen from 3D images to look for the best working position.During the intervention,the most ideal projection image was overlaid on the real fluoroscopy image using 3D navigation technology,and the upper and lower ends of the region of stent placement were decided under 3D navigation guidance.Results Six EVGE procedures were successfully completed without complications such as occlusion of the left subclavian artery ostium or endoleak.One to six months＇ following-up showed that no paraplegia happened and chest and back pain disappeared.Conclusion Inspace iPilot 3D navigation technology is a feasible and effective method for EVGE in the treatment of Stanford type B aortic dissection.