血管腔内裸支架成形术治疗自发性孤立性肠系膜上动脉夹层

Angioplasty with endovascular bare stent placement in treatment of spontaneous isolated dissection of superior mesenteric artery

目的探讨血管腔内裸支架成形术治疗自发性孤立性肠系膜上动脉夹层(SIDSMA)的安全性及有效性。方法回顾性分析经CTA及DSA确诊的15例SIDSMA患者的临床资料。按照Yun分型将SIDSMA分为4型。所有患者均接受SMA腔内裸支架成形术,术后予抗凝治疗2天及抗血小板治疗6个月。术后1、6、12个月及以后每年1次进行临床症状及CTA随访。结果15例患者中Ⅰ型1例,Ⅱa型11例,Ⅱb型3例。技术成功率100%,共植入裸支架22枚,其中行单个裸支架植入8例,双层裸支架重叠植入7例。随访时间5～51个月,平均(30.0±14.5)个月。随访期间未出现症状复发及与支架植入相关并发症;CTA提示SMA支架通畅,夹层重塑。1例患者于术后7个月死于急性心脏疾病。结论血管腔内裸支架成形术治疗SIDSMA是一种安全、有效的方法。

Objective To explore the safety and efficacy of angioplasty with endovascular bare stent placement in treatment of spontaneous isolated dissection of the superior mesenteric artery （SIDSMA）. Methods Clinical date of 15 patients with SIDSMA confirmed by CTA and DSA were retrospectively analyzed. SIDSMA was sorted into four types according to Yun＇s classification. And a 2-day anticoagulation and 6 months antiplatelet therapy were administered postoperatively. Clinical outcome and CTA findings at 1 month, 6 month, 12 month and thereafter per-year were recorded during follow-up. Results There were 1 case in typeⅠ, 11 cases in typeⅡa, 3 cases in type Ⅱb. All the patients were successfully treated with endovascular bare stent placement, with a total of 22 bare stents placement （single stent in 8 patients, double layer overlapping stents in 7 patients）. The mean follow-up duration was （30.0±14.5） months （range 5-51 months） with in-stent patency and dissection remodeling on follow-up CTA and no stent placement related complications and symptom recurrence. One patient died of acute heart attack 7 months after operation. Conclusion It is safe and effective to administer angioplasty with endovascular bare stent placement for the treatment of spontaneous isolated dissection of the superior mesenteric artery.