Talos远端打孔型胸主动脉覆膜支架治疗Stanford B型主动脉夹层首例报告(附视频)  

Talos distal perforating stent-graft in the treatment of Stanford type B aortic dissection: a first case report(with video)

作　　者：吴科敏 何欣[2] 刘毓 黄建华[1] 王伟[1,3] WU Kemin;HE Xin;LIU Yu;HUANG Jianhua;WANG Wei(Department of Vascular Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders(Xiangya Hospital),Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院血管外科,湖南长沙410008 [2]中南大学湘雅医院麻醉科,湖南长沙410008 [3]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008

出　　处：《中国普通外科杂志》2022年第12期1590-1596,共7页China Journal of General Surgery

基　　金：湖南省自然科学基金青年基金资助项目(2022JJ40825)。

摘　　要：背景与目的:主动脉腔内修复术(TEVAR)已成为B型主动脉夹层的一线治疗方式,如何能够最大程度覆盖主动脉夹层破口,促进主动脉重塑,而又不增加截瘫风险成为临床关注的难点。本文主要介绍新型Talos远端打孔型胸主动脉覆膜支架(以下简称“Talos支架”)在中南大学湘雅医院成功完成上市后国内首例支架置入术情况并进行相关分析。方法:报道Talos支架上市后国内首例置入病例的临床资料,并分析Talos支架的优缺点及进行相关文献回顾。结果:72岁男性Stanford B型主动脉夹层患者,因主动脉夹层累及范围广泛,需使用支架长度较长,经本人及家属同意后采用新上市的Talos支架行TEVAR。术中支架轻松到达病变部位,同时定位精准。患者完成支架置入后主动脉破口隔绝完全,假腔完全血栓化,而远端打孔段肋间动脉完整保留,同时无主动脉相关不良事件的发生。结论:Talos支架性能优良,长段的支架主体能够最大程度完成主动脉夹层的破口修复,促进主动脉重塑;同时远端的打孔设计能够在修复夹层破口的同时,保留肋间动脉,预防脊髓缺血所致截瘫。Background and Aims: Thoracic endovascular aortic repair(TEVAR) has become the first-line treatment for type B aortic dissection. Maximizing the aortic dissection coverage and promoting aortic remodeling without increasing the risk of paraplegia has become challenging in clinical practice. Here,the authors report the first case of clinical implantation of the new Talos distal perforating stent(Talos stent) in our country successfully performed in Xiangya Hospital of Central South University after its market release and analyze the related problems.Methods: The clinical data of the first case of implantation of Talos Stent in China after its introduction to the market were reported. The advantages and disadvantages of this type of stent were analyzed and reviewed with a literature review.Results: A 72-year-old male patient with Stanford type B aortic dissection requiring a long-length stent due to the extensive involvement of the aortic dissection underwent TEVAR with the newly-marketed novel Talos stent with the approval of himself and his family. The stent was easily guided towards the lesion during operation with precise positioning. After stenting, the aortic tears of the patient were thoroughly repaired, the false lumens were thrombosed entirely, and the distal intercostal perforating branches were preserved intact, with no development of aortic-related adverse events.Conclusion: The Talos stent has excellent procedural performance, its long body ensures to the maximum extent possible the repair of aortic dissection and promotes aortic remodeling, and the distal perforation design can repair the aortic tears and preserve intercostal branches at the same time, and thereby prevent paraplegia caused by spinal cord ischemia.

关 键 词：动脉瘤 夹层 主动脉 血管内操作 脊髓缺血 Talos支架 

分 类 号：R654.3[医药卫生—外科学]