单分支型主动脉覆膜支架治疗Stanford B型主动脉夹层的临床价值

The application value of single-branch aortic covered-stent in treating aortic dissection of Stanford type B

目的探讨单分支型主动脉覆膜支架在Stanford B型主动脉夹层单纯腔内隔绝治疗中的临床价值。方法2017年7月至2018年10月采用国产CastorTM单分支型主动脉覆膜支架行单纯腔内隔绝治疗19例Stanford B型主动脉夹层患者,观察术后即时血管造影结果。术后1个月门诊随访,术后6个月复查主动脉CTA。以手术成功率、假腔消失率和分支支架通畅率为有效性终点指标,观察相应不良事件。结果19例患者支架均释放成功,技术成功率100%。围手术期无不良事件发生。随访期患者无死亡,4例门诊随访时出现左上肢缺血症状,经对症治疗后缓解。无严重内漏发生,分支支架通畅率100%,夹层假腔均出现血栓化,假腔直径平均缩小(10.3±1.2)mm(肺动脉分叉平面)。结论单分支型主动脉支架对于近端破口距左锁骨下动脉开口<15 mm或逆撕至左锁骨下动脉根部的Stanford B型主动脉夹层,是有效的单纯腔内隔绝方法。

Objective To discuss the clinical value of single-branch aortic covered-stent in treating aortic dissection of Stanford type B.Methods From July 2017 to October 2018,simple endovascular isolation therapy by using domestic CastorTM single-branch aortic covered-stent was adopted to treat 19 patients with aortic dissection of Stanford type B.The immediate postoperative angiographic findings were documented.The patients were followed up at outpatient clinic one month after stent implantation,and reexamination of abdominal aortic CT angiography(CTA)was performed six months after operation.The effective end-point indexes included success rate of surgery,the disappearance rate of false lumen and the patency rate of branch stent.The adverse events were recorded.Results Successful stent release was accomplished in all 19 patients,the technical success rate was 100%.No adverse events were observed in perioperative period.No death occurred during follow-up period.Outpatient clinic follow-up found that 4 patients developed symptoms of left upper limb ischemia,which were relieved after symptomatic treatment.No serious internal leakage occurred,the patency rate of branch stent was 100%,thrombus formation in the false lumen of aortic dissection was seen in all patients,and the diameter of false lumen was decreased by a mean of(10.3±1.2)mm(measured at pulmonary artery bifurcation plane).Conclusion For the treatment of aortic dissection of Stanford type B,in which the distance from its proximal tear to the origin of left subclavian artery was less than 15 mm or the retrograde tear extent was up to the root of the left subclavian artery,single-branch aortic covered-stent implantation is an effective and simple endovascular isolation therapy.