Castor一体式分支支架在胸主动脉瘤治疗中的应用效果

Application effect of unibody single-branched stent graft in the treatment of thoracic aortic aneurysm

目的探讨Castor一体式分支支架在胸主动脉瘤治疗中的应用效果。方法收集佛山市第一人民医院2018年10月至2020年7月应用Castor一体式分支支架治疗的13例需重建左锁骨下动脉(LSA)的胸主动脉瘤患者的临床资料,其中3例患者行颈-颈搭桥联合Castor支架植入,10例患者单纯行Castor支架植入。术后第12个月,全部患者均于门诊复查计算机断层扫描血管造影(CTA)。结果13例重建LSA的胸主动脉瘤患者均成功完成Castor单分支支架植入手术,手术技术成功率100%;手术平均时间为(174±56)min;术中1例患者LSA分支支架释放后存在狭窄,给予球囊扩张后狭窄解除;术中有1例因LSA分支支架部分遮挡左椎动脉,遂植入支架开通椎动脉;术中有1例因瘤体较大出现主体支架近端缩入瘤体致Ia型内漏,遂行无名动脉开窗术,术后无名动脉血流通畅,内漏消失;术后无左上肢缺血、内漏、脑梗死、死亡病例发生。随访至12个月时,LSA分支支架的通畅率为100%,无截瘫、新发内漏、死亡病例。结论Castor一体式分支支架应用于重建LSA的胸主动脉瘤患者治疗中,短期疗效满意,安全可靠,并发症少,值得临床推广。

Objective To investigate the effect of Castor unibody single-branched stent graft in the treatment of the thoracic aortic aneurysm.Method The clinical data of 13 patients with thoracic aortic aneurysm who received the reconstruct the left subclavian artery(LSA)and implanted with Castor unibody single-branched stent graft from October 2018 to July 2020 in the First People's Hospital of Foshan were collected,of which 3 patients underwent neck-neck bypass combined with Castor stent implantation,and 10 patients underwent Castor stent implantation alone.At 12 months after surgery,all patients were checked in the outpatient department with computed tomography angiography(CTA).Result Thirteen patients with thoracic aortic aneurysms reconstructed with LSA completed the Castor unibody single-branched stent graft implantation,and the technique success rate was 100%,the average operation time was(174±56)min.During the operation,1 case had stenosis after the release of the LSA branch stent,and the stenosis was relieved after balloon expansion.During the operation,1 case suffered partially blocked the left vertebral artery owing to the LSA branch stent,and thus the stent was implanted to open the vertebral artery.During the operation,1 case of type Ia internal leakage caused by the proximal end of the main stent retracted into the tumor body due to the large tumor body underwent fenestration of the innominate artery.After the operation,blood flow in the innominate artery was smooth and the internal leakage disappeared.There were no cases of left upper limb ischemia,internal leakage,cerebral infarction,or death reported during the operation.At the 12-month follow-up,the patency rate of the LSA branch stent was 100%,and no cases of paraplegia,new internal leakage,and deaths were reported.Conclusion The implantation of Castor unibody single-branched stent graft in the treatment of thoracic aortic aneurysm patients with reconstructed LSA could meet satisfactory short-term curative effects with safe and reliable,and fewer complications,which is worthy of clinical promotion.