挑战主动脉弓:目前证据与未来走向

Challenge aortic arch:current evidence and future trend

传统开放手术处理主动脉弓部病变的病死率和中风发生率分别高达6%～20%和3%～15%。如何利用胸主动脉腔内修复术(thoracic endovascular repair,TEVAR)是处理主动脉弓部病变的热点。目前,主动脉弓TEVAR技术方案主要基于常规器材和新器材两大方面。前者主要包括"杂交"技术和"烟囱"技术,应用相对较多,都有一定数量的临床研究,且早中期结果令人满意;后者包括"开窗"、"模块化支架"、"多分支支架"等技术,均仅仅是一些病例报道,应用不多。因此,实现主动脉弓微创腔内重建的根本问题和出路在于新的腔内器材的设计与研发。笔者认为"分支"设计可能更适合主动脉弓解剖学特点。

Conventional repair of aortic arch pathology is associated with significant mortality and stroke rates of 6% 20% and 3%-15%, respectively, So thoracic endovascular repair （TEVAR） in the management of aortic arch lesions is the trending topic. Until now, TEVAR involving aortic arch has been based on conventional or new devices. The former includes ＂hybrid/ de-branching＂ and ＂chimney＂ techniques, which were more often used clinically. There were some studies about the techniques, and the early and midterm outcomes were favorable. The latter includes ＂fenestrated stent graft＂ , ＂modular branched stent graft＂, ＂multiranched stent graft＂ , and so on. There were only a few case reports or other studies, and the experiences were limited. So the key solution about total TEVAR of aortic arch pathology is to design and develop new endovascular device. ＂branched stent graft＂ might match with aortic arch anatomy characteristics more.