主动脉定制开窗支架治疗主动脉弓动脉瘤中国首例报告(附视频)

Customized fenestrated aortic stent-graft for aortic arch aneurysm:report of first case in China(with video)

背景与目的:胸主动脉腔内修复术(TEVAR)治疗胸主动脉病变已逐渐成为一线手术方案。然而,受限于主动脉弓部复杂解剖结构,在治疗病变的同时如何有效重建弓部分支动脉是应用当前标准化产品常有的困境。鉴于此,笔者团队与支架厂家合作开发了Castor胸主动脉定制开窗覆膜支架(以下简称Castor定制开窗支架),并实施了国内首例Castor定制开窗支架的置入。本文对此作一汇报。方法:报告国内首例Castor定制开窗支架置入病例的临床资料、支架定制情况与手术过程,并进行Castor定制开窗支架的优缺点分析与相关文献复习。结果:患者为59岁男性,于TEVAR术后14年发生主动脉弓部动脉瘤,病变累及左侧锁骨下动脉(LSA)、左颈总动脉(LCCA)。经患者及家属同意后采用Castor定制开窗支架隔绝动脉瘤,手术规划拟采用Castor定制开窗支架隔绝动脉瘤,将Castor支架分支置入LCCA;术前定制开窗分别重建无名动脉(IA)和LSA。术中成功置入Castor单分支支架并顺利重建弓部三根分支动脉,术后复查结果提示动脉瘤隔绝满意无内漏,弓部三根分支动脉通畅,同时无主动脉相关不良事件的发生。结论:Castor个体化定制开窗支架性能优良,能够契合患者解剖条件,完全隔绝瘤体,同时实现精准开窗重建弓部分支动脉,且避免破坏支架完整性,为临床精准医疗提供了手段。

Background and Aims:Thoracic endovascular aortic repair(TEVAR)has gradually become a the firstline therapeutic option for thoracic diseases.However,hindered by the complex anatomical structure of the aortic arch,effectively reconstructing supra-arch arteries during lesion treatment is a common challenge when using current standardized products.Given this,our team,collaborating with a stent manufacturer,had developed the Castor customized fenestrated thoracic stent-graft(hereafter referred to as Castor customized fenestrated stent)and successfully performed the first case of Castor customized fenestrated stent implantation in China.This article provides a report on this.Methods:The clinical data,stent customization details,and surgical procedure for the first case of Castor customized fenestrated stent implantation in China were described,and an analysis of the advantages and disadvantages of the Castor customized fenestrated stent and review of relevant literature were also conducted.Results:The patient,a 59-year-old male who underwent TEVAR 14 years ago,developed an aortic arch aneurysm involving the left subclavian artery(LSA)and left common carotid artery(LCCA).With the patient's and family's consent,we utilized the Castor fenestrated stent to seal the aneurysm.The surgical plan involved using the Castor customized fenestrated stent to occlude the aneurysm and placing the Castor stent branch into the LCCA.Preoperatively,fenestrations were customized to separately reconstruct the innominate artery(IA)and LSA.Successful implantation of the Castor single branch stent was achieved during surgery,effectively reconstructing the three supra-arch arteries.Postoperative imaging confirmed satisfactory aneurysm occlusion with no endoleak,patent flow in the three branch arteries,and no occurrence of adverse events related to the aorta.Conclusion:The performance of the Castor individualized fenestrated stent is excellent,fitting the patient's anatomical characteristics,completely isolating the aneurysm,and enabling precise fenestration for reconstruction of the supra-arch arteries.Importantly,it avoids compromising stent integrity,providing a means for precise clinical interventions.