分支支架技术在弓部分支血管重建中的应用及评价

Application and evaluation of branched stent-graft technique in reconstruction of aortic arch branches

分支支架技术在腔内治疗累及主动脉弓的主动脉瘤或主动脉夹层中,更符合正常解剖结构的修复,国内外进行了大量研究。国内包括头端连接式分支支架、分叉拼接式分支支架,由于设计缺陷及释放方式问题,临床试验失败;国外包括日本的Inoue一体化分支支架,临床试验亦失败。Cook公司的"内烟囱"分支支架、Bolton Medical公司的大窗内烟囱分支支架、Gore公司的内潜望镜分支支架、Medtronic公司的突起开窗连接式分支支架,正在进行临床试验,但均未获得上市批准。Castor分支支架是国际上首款获得国家级审批并可作为商品销售的分支支架,由海军军医大学附属长海医院血管外科与上海微创公司联合研发。其支架的一体化设计及输送释放系统的安全性及精准性设计使其获得了良好的临床应用结果。但Castor分支支架为单分支支架,其应用仍有一定的局限性,要完全解决主动脉弓部病变仍需要进一步的研究。多种技术的结合可能是未来5年内解决主动脉弓部病变问题的发展方向。

Branched stent-graft technique is more suitable for endovascular treatment of aortic aneurysms or dissection involving the aortic arch,with more in line with normal anatomical structure and lots of researches have been done all over the world.In China,there are head attached branched stent-graft and bifurcated spliced branched stent-graft.But clinical trials of them failed due to design defects and release methods problem.Japanese Inoue integrated branched stent-graft either failed.Other overseas including Cook's "inner chimney"branched stent-graft,Bohon Medical's large window inner chimney branched stent-graft,Gore's inner periscope branched stent-graft,Medtronic's protruding window connecting branched stent-graft are undergoing clinical trials,but none has been approved by the public. Castor branched stent-graft is the first branched stent-graft approved by the state in the world.It can be used as a commercial branched stent-graft.It was jointly developed by Department of Vascular Surgery,Shanghai Changhai Hospital and Shanghai MicroPort Company.The integrated design of the stent and the safety and precision design of the delivery and release system make it obtain good clinical application results.However,Castor branched stent-graft is a single branched stent-graft,its application still has some limitations, to completely solve the aortic arch lesions still need further research.The combination of various technologies may be the direction of endovascular repair of aortic arch lesions in the next 5 years.