裸支架烟囱技术治疗主动脉夹层伴左颈总动脉破口

The application of bare-stent “chimney” technique in treating aortic dissection complicated by left common carotid rupture

目的探讨裸支架“烟囱”技术在主动脉夹层伴左颈总动脉破口腔内隔绝术中的应用及治疗效果。方法回顾性分析2012年2月至2014年3月青海省人民医院采用裸支架“烟囱”技术行腔内隔绝术治疗的7例主动脉夹层伴左颈总动脉破口患者的临床资料。在腔内覆膜支架封堵主动脉夹层破口的同时，以“烟囱”裸支架隔绝左颈总动脉破口，重建左颈总动脉血流。术后2周行CTA检查，观察疗效及有无内漏、支架移位等并发症。结果腔内隔绝手术成功率为100％，无I型内漏发生。术后随访1-13个月，主动脉内覆膜支架位置良好，左颈总动脉内“烟囱”支架通畅，无内漏、支架移位等并发症发生。结论裸支架“烟囱”技术可以为主动脉夹层伴左颈总动脉破口患者提供腔内隔绝术治疗机会．完全封堵漏口。重建血流。短期随访疗效满意，远期疗效有待进一步随访观察。

Objective To discuss the application of bare-stent ＂chimney＂ technique in treating aortic dissection associated with left common carotid rupture, and to evaluate its therapeutic effect. Methods The clinical data of 7 patients with aortic dissection accompanied with left common carotid rupture, who were admitted to Qinghai Provincial People＇s Hospital during the period from February 2012 to March 2014 to receive endovascular isolation operation treatment with bare-stent ＂chimney＂ technique, were retrospectively analyzed. When the rupture of aortic dissection was occluded with covered-stent, the left common carotid rupture was isolated with ＂chimney＂ bare-stent to reconstruct the blood flow of left common carotid artery. CT angiography was performed 2 weeks after the operation to check if there was any complication such as endoleak, stent migration, etc. Results The technical success rate of endovascular isolation operation was 100%. No type I endoleak occurred. The patients were foUowed up for 1-13 months, the covered stent in the aorta was in good position, and the ＂chimney＂ bare-stent in the left common carotid artery was patent. No complications such as endoleak, stent migration, etc. occurred. Conclusion Bare-stent ＂chimney＂ technology can provide treatment opportunity for the patients suffering from left common carotid artery rupture accompanied by aortic dissection; the rupture can he completely obstructed and the blood flow can be reconstructed. The short-term effect is satisfactory, although the long-term effect needs to be further studied. （J Intervent Radiol, 2015, 24： 767-770）