胸主动脉腔内修复术中封堵左锁骨下动脉对缺血性脑卒中的影响  

Effect of left subclavian artery coverage on ischemic stroke during thoracic endovascular aortic repair

作　　者：张韬[1] 李清乐[1] 张学民[1] 李伟[1] 张小明[1] Zhang Tao;Li Qingle;Zhang Xuemin;Li Wei;Zhang Xiaoming(Department of Vascular Surgery of Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院血管外科,100044

出　　处：《中华普通外科杂志》2019年第2期113-117,共5页Chinese Journal of General Surgery

基　　金：北京市科技计划项目(Z151100004015142).

摘　　要：目的探讨胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)中封堵左锁骨下动脉(left subclavian artery,LSA)对缺血性脑卒中的影响。方法回顾性分析2013年6月—2018年1月69例LSA完全封堵且未重建的TEVAR患者病例和术后6个月的随访资料。结果患者男56例,女13例,平均年龄51.1(32~76)岁。围手术期死亡3例,死亡率4.3%(3/69),卒中相关死亡率1.4%(1/69)。围手术期症状性脑卒中2例(}3.0%),隐匿性脑卒中5例(5/66,7.6%);其中前循环缺血2例(2/66,3.0%)、后循环缺血3例(3/66,4.5%),多发性缺血2例(2/66,3.0%);椎动脉窃血分级,Ⅰ度48例(72.7%),Ⅱ度15例(22.7%),Ⅲ度3例(4.5%)。截至术后6个月无新发卒中相关死亡,症状性脑卒中3例(3/66,4.5%),隐匿性脑卒中13例(13/66,19.7%);前循环缺血3例(3/66,4.5%),后循环缺血8例(8/66,12.1%),多发性缺血5例(5/66,7.6%)。结论LSA自身的代偿机制降低了TEVAR封堵LSA导致的严重缺血性脑卒中风险。Objective To investigate the effect of left subclavian artery (LSA) coverage on ischemic stroke complications in thoracic aortic cavity repair (TEVAR). Methods The clinical data of 69 patients undergoing TEVAR with LSA coverage from Jun 2013 to Jan 2018 were retrospectively analyzed. Results There were 56 males and 13 females,average age of 51.1(32-76).Perioperative mortality was 4.3% (3/69) and stroke related mortality was 1.4% (1/69).There were 2 cases (2/66,3.0%) of symptomatic stroke in perioperative period and 5 cases (5/66,7.6%) of cryptogenic stroke,inclucling 2 cases of anterior circulation ischemia (2/66,3.0%),3 cases of posterior circulation ischemia (3/66,4.5%),and 2 cases of multiple ischemia (2/66,3.0%).48 cases (72.7%) of vertebral blood steal were grade Ⅰ,15 cases (22.7%) were Ⅱ and 3 cases (4.5%) were Ⅲ.No new stroke related deaths happened in 6 months,there were 3 cases of symptomatic stroke (3/66,4.5%) and 13 cases of cryptogenic stroke (13/66,19.7%) .There were 3 cases of anterior circulation ischemia (3/66,4.4%),8 cases of posterior circulation ischemia (8/66,12.1%) and 5 cases of multiple ischemia (5/66,7.6%) respectively. Conclusion The compensation mechanism of LSA itself reduces the serious ischemic stroke risk caused by LSA coverage.

关 键 词：动脉瘤 夹层 锁骨下动脉 脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]