主动脉支架体外开窗与Castor分支型覆膜支架TEVAR重建LSA治疗主动脉弓部病变的临床疗效比较  

Comparison of Clinical Efficacy between Extracorporeal Aortic Stent Fenestration and Castor Branch Covered Stent TEVAR for LSA Reconstruction in Treatment of Aortic Arch Lesions

作　　者：李晓恒[1] 李燕平[1] 付晓可 李斌[1] LI Xiaoheng;LI Yanping;FU Xiaoke(Luoyang Central Hospital,Luoyang Henan 471000)

机构地区：[1]洛阳市中心医院,河南洛阳471000

出　　处：《医学临床研究》2024年第6期842-845,共4页Journal of Clinical Research

摘　　要：【目的】比较主动脉支架体外开窗与Castor分支型覆膜支架主动脉腔内修复术(TEVAR)重建左锁骨下动脉(LSA)治疗主动脉弓部病变的临床疗效。【方法】选取2020年1月至2023年1月本院收治的71例主动脉弓部病变的患者,根据LSA重建方式不同将其分为体外开窗组(主动脉支架体外开窗,n=51)和外分支组(Castor分支型覆膜支架TEVAR重建LSA,n=21)。比较两组患者围术期指标、手术成功率及术后并发症发生率,1年后随访预后情况,夹层术后的夹腔重塑情况及患者假腔血栓化情况。【结果】外分支组手术时间、器械释放成功率、手术费用均高于体外开窗组(P<0.05)。支架段L1、L3、L4,外分支组真腔面积变化率[R(ATL)]高于体外开窗组(P<0.05);支架段L3外分支组假腔面积变化率[R(AFL)]、真腔直径变化率[R(DTL)]高于体外开窗组,L4 R(DTL)高于体外开窗组(P<0.05)。两组患者假腔血栓化程度再支架段和非支架段比较,差异均无统计学意义(P>0.05)。【结论】主动脉支架体外开窗与Castor分支型覆膜支架TEVAR重建LSA治疗主动脉弓部病变均具有良好的安全性与有效性,Castor分支型覆膜支架TEVAR操作时间较短且支架近端重塑效果优于体外开窗TEVAR。【Objective】To compare the clinical efficacy of extracorporeal aortic stent fenestration and Castor branch covered stent for thoracic endovascular aortic repair(TEVAR)reconstructing the left subclavian artery(LSA)in the treatment of aortic arch lesions.【Methods】A total of 71 patients with aortic arch lesions admitted to our hospital from January 2020 to January 2023 were selected and divided into an extracorporeal window group(aortic stent extracorporeal window opening,n=51)and an extracorporeal branch group(Castor branch covered stent TEVAR reconstruction LSA,n=21)based on different LSA reconstruction methods.The perioperative indicators,surgical success rate,and postoperative complication incidence of the two groups of patients were compared;The follow-up prognosis after 1 year showed the remodeling of the sandwich cavity and the patient's false lumen thrombosis after the dissection surgery.【Results】The surgical time,success rate of instrument release,and surgical cost of the external branch group were all higher than those of the external window group(P<0.05).The change rate of true lumen area[R(ATL)]in the L1,L3,and L4 stent segments and the external branch group was higher than that in the external fenestration group(P<0.05);The false lumen area change rate[R(AFL)]and true lumen diameter change rate[R(DTL)]in the L3 external branch group of the stent segment were higher than those in the in vitro fenestration group,while the L4 R(DTL)was higher than those in the in vitro fenestration group(P<0.05).There was no statistically significant difference in the degree of false lumen thrombosis between the two groups of patients in the stent and non stent segments(P>0.05).【Conclusion】Both extracorporeal stent fenestration and Castor branch coated stent TEVAR for LSA reconstruction in treatment of aortic arch lesions have good safety and effectiveness.Castor branch coated stent TEVAR has a shorter operating time and better proximal stent remodeling effect than extracorporeal fenestration TEVAR.

关 键 词：主动脉疾病/外科学 支架 治疗结果 

分 类 号：R543.16[医药卫生—心血管疾病]