应用裸支架治疗急性Stanford A型主动脉夹层的疗效

Evaluation of the efficacy of restricted bare stent in the treatment of acute stanford A aortic dissection

目的评价限制性裸支架应用于急性Stanford A型主动脉夹层支架象鼻远端的疗效。方法 2016年11月至2018年2月,我院大血管中心对20例急性Stanford A型主动脉夹层需做主动脉弓置换+支架象鼻手术的患者同时行限制性裸支架置入。其中男17例,女3例;年龄34~68岁,平均(50.85±8.49)岁。在胸降主动脉内释放裸支架,再将支架象鼻置于裸支架内,出院前复查主动脉CTA,观察支架位置及并发症情况。与我院大血管中心2013年12月到2015年6月期间因急性Stanford A型主动脉夹层常规行主动脉弓置换+支架象鼻手术的42例患者进行对比。42例患者中,男32例,女10例;年龄20~78岁,平均(49.36±8.02)岁。结果裸支架组1例置入裸支架时阻力较大,自行脱出放弃置入;19例成功置入限制性裸支架,术后1例住院期间因大面积脑梗塞死亡。18例生存患者均定期随访,随访期内无卒中、死亡,计算机体层扫描血管成像检查支架形态、位置良好,无移位及Ⅲ型内漏,未见象鼻支架远端新发破口。常规手术组2例死亡,1例术后出现大面积脑梗塞,1例为围手术期心肌梗死;无截瘫病例;2例出现象鼻支架远端新发破口,再次行胸腹主支架置入术。结论相比常规手术组,使用限制性裸支架安全,能有效减少支架源性新发破口的发生且可以明显扩张远端血管真腔直径,主动脉重塑效果良好。

To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection. Methods From November 2016 to February 2018, 20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement. Among them, there were 17 males and 3 females, aged 34-68 years old with an average age of(50.85±8.49) years. The bare stent was released in the descending thoracic aorta, and the frozen elephant trunk was placed in the bare stent. The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed. And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients, 32 were males and 10 were females, aged 20-78 years, with an average of(49.36±8.02) years. Results One patient in the bare stent group had greater resistance when the bare stent was placed, and the patient was disengaged and abandoned. The remaining 19 patients successfully completed the restrictive bare stent placement. One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly. There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position, no displacement and type Ⅲ endoleak, and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group, 2 patients died, 1 patient died of large-scale cerebral infarction, and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases, a new rupture of the distal end of the elephant trunk was performed, and the stent was placed again. Conclusion Compared with the conventional surgery group, the use of the restricted bare stent is safe, can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel, and the aortic remodeling effect is good.