血管腔内支架成形术治疗孤立性肠系膜上动脉夹层的疗效

Efficacy of angioplasty with endovascular stent placement for isolated superior mesenteric artery dissection

目的:评价血管腔内支架成形术治疗孤立性肠系膜上动脉夹层(ISMAD)的安全性及有效性。方法:回顾性分析了2013年1月至2018年1月经CTA及DSA明确诊断的11例ISMAD患者的临床资料,按照Yun分型,其中Ⅱa型5例,Ⅱb型5例,Ⅲ型1例。所有患者均行肠系膜上动脉血管腔内支架成形术,术后继续抗凝抗血小板治疗。结果:11例患者均成功植入支架,其中单层裸支架植入3例,双层裸支架植入7例,覆膜支架植入1例,所有病例术后20 d内症状完全消失。随访时间3~24个月,期间未见症状复发,肠系膜上动脉CTA显示假腔消失,支架内血流通畅;其中2例双层裸支架植入患者出现支架内狭窄,狭窄率均<30%。结论:血管腔内支架成形术是治疗ISMAD的一种安全、有效的办法。

Aim:To evaluate the safety and efficacy of angioplasty with endovascular stent placement in treatment of isolated superior mesenteric artery dissection(ISMAD).Methods:The clinical data of 11 ISMAD patients who were admitted in from January 2013 to January 2018 were retrospectively analyzed.The diagnosis was confirmed by CTA and DSA.According to Yun angiographic categorization,there were typeⅡa(5 cases),typeⅡb(5 cases)and typeⅢ(1 case).They were all treated by angioplasty with endovascular stent placement.Fasting together with antiplatelet and anticoagulation therapy were employed.Results:All the patients were successfully treated with the endovascular stent placement,including single bare stent(3 cases),double layer overlapping stents(7 cases),covered stent(1 case).The clinical symptoms in all patients disappeared gradually within 20 days.The follow-up time was 3-24 months.In-stent patency and dissection remodeling were observed in follow-up CTA and no recurrence.Two patients with double layer overlapping stents placement had stent stenosis,and the stenosis rate was less than 30%.Conclusions:Angioplasty with endovascular stent placement is safe and effective for the treatment of ISMAD.