覆膜支架治疗左侧锁骨下动脉狭窄球囊成形术致主动脉夹层1例——个案报道并文献复习

Covered stent in the treatment of aortic dissection caused by balloon angioplasty of left subclavian artery stenosis-a case report and literature review

目的报道1例覆膜支架治疗左侧锁骨下动脉狭窄球囊成形术致主动脉夹层患者并复习相关文献。方法回顾性分析2021年12月14日昆明市第一人民医院收治的1例左侧锁骨下动脉狭窄患者的临床资料,并复习国内外相关文献,分析锁骨下动脉狭窄的手术方式、注意事项、术中并发症及其处理原则。结果本报道患者为左侧锁骨下动脉狭窄,术中出现锁骨下动脉-胸主动脉夹层,造影剂渗出。使用血管覆膜支架覆盖破口,再次造影无动脉造影剂持续渗出,术后经胸部增强CT明确诊断,本次手术并发症考虑由球囊扩张成形过程中球囊对血管的扭矩和剪切力造成,半年后复查未见动脉造影剂渗出,未见主动脉夹层。结论覆膜支架治疗左侧锁骨下动脉狭窄球囊成形术致主动脉夹层的效果良好。神经介入医师应对经皮血管腔内成形术并发症予以重视,做到尽早发现并做出正确的诊断,尽快对并发症进行正确的处理,避免病情进一步恶化,尽可能减少并发症带来的不良后果,提高临床治疗效果,改善预后。

Objective To report a case of aortic dissection caused by balloon angioplasty for left subclavian artery stenosis treated with covered stent,and to review the related literature.Methods The clinical data of one patient with left subclavian artery stenosis admitted in the First Hospital of Kunming from December 14,2021 were retrospectively analyzed,and the relevant literatures at home and abroad were reviewed to analyze the surgical methods,precautions,intraoperative complications and treatment principles of subclavian artery stenosis.Results In this report,the patient had left subclavian artery stenosis,during the operation,there was subclavian artery-thoracic aortic dissection with contrast agent exudation.The vascular covered stent was used to cover the rupture,and there was no continuous exudation of arterial contrast agent in the re-angiography;after the operation,the diagnosis was confirmed by chest enhanced CT;the complications of this operation were considered to be caused by the torque and shear force of the balloon on the blood vessel during balloon dilatation;after half a year,there was no arterial contrast agent exudation and aortic dissection.Conclusion The covered stent in the treatment of aortic dissection caused by balloon angioplasty of left subclavian artery stenosis has good effect.Neurointerventional physicians should pay attention to the complications of percutaneous endovascular angioplasty,so as to find and make correct diagnosis as early as possible,deal with the complications as soon as possible,avoid further deterioration of the disease,minimize the adverse consequences of complications,promote the clinical treatment effect and improve the prognosis.