累及左锁骨下动脉的Standford B型主动脉夹层中castor分支型覆膜支架的应用效果及对主动脉重塑的影响

Effect of Castor Branch Covered Stent in Standford B Aortic Dissection Involving the Left Subclavian Artery and Its Influence on Aortic Remodeling

目的 研究累及左锁骨下动脉(LSA)的Standford B型主动脉夹层(TBAD)中castor分支型覆膜支架(简称castor支架)的应用效果及对主动脉重塑的影响。方法 纳入无锡明慈心血管病医院收治的58例TBAD患者,根据治疗方法分为castor组(31例)和对照组(27例)。对照组接受烟囱技术,castor组接受castor支架进行治疗。比较两组的手术相关指标、围手术期并发症。对两组进行随访,比较随访期间上肢缺血、脑梗死、内漏、LSA窃血、夹层逆撕等晚期并发症的发生率。比较两组术后2周和术后6个月时的主动脉重塑指标。结果 castor组透视时间、手术时间均长于对照组(P<0.05)。castor组围手术期并发症发生率低于对照组(P<0.05)。castor组随访期间晚期并发症发生率低于对照组(P<0.05)。术后6个月,castor组假腔完全血栓化比率高于对照组(P<0.05)。结论 虽然与烟囱技术相比,castor支架治疗累及LSA的TBAD透视时间和手术时间延长,但是围手术期并发症和晚期并发症发生率较低,且有助于患者的假腔血栓化。

Objective To study the effect of castor branch covered stent(castor stent)in Standford type B aortic dissection(TBAD)involving the left subclavian artery(LSA)and its influence on aortic remodeling.Methods A total of 58 TBAD patients admitted to Wuxi Mingci Cardiovascular Hospital were divided into castor group(31 cases)and control group(27 cases)based on treatment methods.The control group received chimney technology,while the castor group received castor stents for treatment.The surgical related indicators and perioperative complications between the two groups were compared.The incidence of late complications such as upper limb ischemia,cerebral infarction,internal leakage,LSA steal,and dissection reverse tearing during the follow-up period between the two groups were compared.The aortic remodeling indicators between the two groups at 2 weeks and 6 months after surgery were compared.Results The fluoroscopy time and surgical time in the castor group were longer than those in the control group(P<0.05).The incidence of perioperative complications in the castor group was lower than that in the control group(P<0.05).The incidence of late complications during follow-up in the castor group was lower than that in the control group(P<0.05).At 6 months after surgery,the false lumen complete thrombosis rate in the castor group was higher than that in the control group(P<0.05).Conclusion Although castor stent treatment involves longer TBAD fluoroscopy time and surgical time for LSA compared to chimney technology,the incidence of perioperative and late complications are lower,and it helps patients with false lumen thrombosis.