主动脉腔内修复术中植入不同设计种类覆膜支架对急性Stanford B型主动脉夹层患者近、远期疗效影响

Different covered stent designs on the short and long term efficacy of thoracic endovascular aortic repair in patients with acute Stanford B-type aortic dissection

目的 评价主动脉腔内修复术(TEVAR)中植入不同设计种类覆膜支架对急性Stanford B型主动脉夹层(ATBAD)患者近、远期疗效的影响。方法 选取自2017年1月至2022年12月于北部战区总医院行TEVAR治疗的665例ATBAD患者为研究对象。根据术中植入的支架近端有无金属裸区,将患者分为裸区组(n=338)与无裸区组(n=327)。观察两组术后30 d及术后1年临床不良事件的发生情况。结果 两组患者随访30 d全因死亡、主动脉源性死亡、其他原因死亡、缺血性卒中、主动脉不良事件、再发夹层、内漏、支架远端溃疡等并发症发生率比较,差异均无统计学意义(P>0.05)。两组患者随访1年全因死亡、主动脉源性死亡、其他原因死亡、缺血性卒中、再发夹层、支架远端溃疡发生率比较,差异均无统计学意义(P>0.05)。无裸区组患者随访1年主动脉不良事件、内漏发生率均高于裸区组,差异均有统计学意义(P<0.05)。结论 对于ATBAD患者,行TEVAR治疗时选用近端有裸区支架可显著降低患者术后远期主动脉相关不良事件及内漏发生率。

Objective To evaluate the impact of different covered stent designs on the short and long term efficacy of thoracic endovascular aortic repair(TEVAR)in patients with acute Stanford B-type aortic dissection(ATBAD).Methods A total of 665 patients diagnosed with ATBAD and treated with TEVAR were selected from General Hospital of Northern Theater Command from January 2017 to December 2022.Patients were divided into proximal bare stent group(n=338)and no proximal bare stent group(n=327)according to whether there was a bare metal area in the proximal end of the stent implanted during the operation.The occurrence of clinical adverse events 30 days and 1 year after surgery were observed in the two groups.Results There was no significant difference in the incidence of all-cause death, aortic death, death from other causes, ischemic stroke, aortic adverse events, rehairpin layer, internal leakage, distal stent ulcer and other complications between two groups after 30 days of follow-up(P>0.05).There was no significant difference in the incidence of all-cause death, aortic death, death from other causes, ischemic stroke, rehairpin layer and distal stent ulcer between two groups during 1 year follow-up(P>0.05).The incidence of aortic adverse events and internal leakage in no proximal bare stent group was higher than that in proximal bare stent group at 1 year follow-up, and the differences were statistically significant(P<0.05).Conclusion The use of proximal bare stent in TEVAR treatment for ATBAD patients can significantly reduce the rate of post-operative long-term aortic-related adverse events and endoleak.