一体式分支支架在近端锚定区严重不足Stanford B型主动脉夹层中应用价值

Clinical application of one-piece branched stent in Stanford B aortic dissection with severely inadequate of proximal anchoring zone

目的探讨Castor一体式分支型主动脉覆膜支架治疗近端锚定区≤5 mm的Stanford B型主动脉夹层(TBAD)的临床效果,并总结应用经验。方法回顾性分析北部战区总医院自2018年5月至2021年7月应用Castor支架治疗的10例经计算机断层扫描血管造影(CTA)确诊近端锚定区≤5 mm的TBAD患者的临床资料。记录患者的基线资料、围术期情况及随访结果。结果10例患者中,9例Castor一体式分支支架释放顺利;1例分支支架释放困难,释放后左锁骨下动脉存在夹层、狭窄,植入金属裸支架1枚。手术成功率为100.0%(10/10),围术期无脑梗死、主动脉夹层动脉破裂或进展、截瘫、分支血管缺血等并发症,无死亡患者。术后1年时,10例患者均存活,复查CTA提示支架形态良好,分支支架均通畅,仅1例(10.0%,1/10)支架近端出现少量Ⅰa型内漏,但内漏量较小,患者无不适症状,未处理,定期影像学复查。结论Castor一体式分支型主动脉覆膜支架治疗近端锚定区严重不足的TBAD临床效果好,安全性高,可使更多患者获益,避免外科手术创伤。

Objective To investigate the clinical effect of Castor integrated branched aortic stent-graft in the treatment of Stanford B aortic dissection(TBAD)with severely inadequate of proximal anchoring zone,and summarize the application experience.Methods A retrospective analysis was performed on the clinical data of 10 patients with TBAD whose proximal anchorage area≤5 mm were confirmed by computed tomngraphy angiography(CTA)and treated with Castor stents in General Hospital of Northern Theater Command from May 2018 to July 2021.Baseline data,perioperative conditions and follow-up results were recorded.Results In 10 patients,9 patients had successful release of the Castor integrated branching stent,1 case had difficulty in releasing the branching stent.After releasing,the left subclavian artery was interlayer and stenosis,and 1 bare metal stent was implanted.The operative success rate was 100.0%(10/10),and there were no perioperative complications such as cerebral infarction,aortic dissection artery rupture or progression,paraplegia,branch vascular ischemia,and no death cases.After 1 year follow-up,all 10 patients survived,and all of them were reexamined with CTA.CTA suggested that the stent was in good shape and the branching stent was unobstructed.Only 1 case(10.0%,1/10)had a small amount of internal leakage at the proximal end of the stent,but the amount of internal leakage was small.The patient had no discomfort and was not treated.Conclusion Castor integrated branching aortic stent has good clinical efficacy and high safety in the treatment of TBAD with severely inadequate proximal anchoring area.