| 41 | 0 | 32 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 比较采用Castor单分支支架（一体式单分支覆膜支架输送系统）与Longuette烟囱支架（主动脉-分支动脉覆膜裙边型烟囱支架系统）技术治疗急性期累及左锁骨下动脉（LSA）的Stanford B型主动脉夹层（TBAD）对重塑主动脉、假腔血栓化、术后并发症影响。方法 对2022年6月至2024年6月收治的急性期累及LSA的TBAD患者73例的临床资料进行回顾性研究。按治疗方法将采用Longuette烟囱支架治疗的37例作为Longuette组，采用Castor单分支支架治疗的36例作为Castor组。比较两组术中指标与住院时间、重塑主动脉情况、术后6个月假腔血栓化情况、近中期并发症。结果 Castor组手术时间、X线透视时间长于Longuette组（P<0.05）;Castor组术中出血量、住院时间与Longuette组比较差异无统计学意义（P>0.05）。Castor组术后2周、6个月真腔体积增加率、远端真腔最长径增加率、支架远端面积与Longuette组比较差异无统计学意义（P>0.05）；与术后2周比较，两组术后6个月真腔体积增加率、远端真腔最长径增加率、支架远端面积均增加（P<0.05）。两组术后6个月假腔血栓化率比较差异无统计学意义（P>0.05）。Castor组近期并发症总发生率[5.56%(2/36)]低于Longuette组[21.62%(8/37)](P<0.05);Castor组中期并发症发生率[2.78%(1/36)]与Longuette组[8.11%(3/37)]比较差异无统计学意义（P>0.05）。结论 Castor单分支支架与Longuette烟囱支架技术治疗急性期累及LSA的TBAD均可获得良好的效果及安全性，二者在促进主动脉重塑与假腔血栓化方面效果相当。然而，Castor单分支支架技术虽具有较长的手术时间与X线透视时间，但在降低内漏、支架移位等近期并发症风险方面具有优势，展现了更好的早期安全性。
Abstract：Objective To compare the effects of Castor single-branch stent(integrated single-branch covered stent delivery system) and Longuette chimney stent(aortic-branch artery covered skirt-type chimney stent system) techniques on aortic remodeling, false lumen thrombosis, and postoperative complications in the treatment of acute Stanford type B aortic dissection(TBAD) involving the left subclavian artery(LSA). Methods A retrospective study was conducted on the clinical data of 73 patients with TBAD involving the LSA in the acute phase who were admitted between June 2022 and June 2024. According to the treatment method, 37 patients treated with Longuette chimney stent were assigned to the Longuette group, and 36 patients treated with Castor single-branch stent were assigned to the Castor group. The intraoperative indicators, length of hospital stay, aortic remodeling, false lumen thrombosis at 6 months post-operation, and short-and medium-term complications were compared between the two groups. Results The duration of operation and X-ray fluoroscopy time in the Castor group were longer than those in the Longuette group(P<0.05). There was no significant difference in intraoperative blood loss and length of hospital stay between Castor group and Longuette group(P>0.05). There was no significant difference in the increase rate of true lumen volume, the increase in the maximum diameter of the distal true lumen, and the area distal to the stent between the Castor group and the Longuette group at 2 weeks and 6 months after operation(P>0.05). Compared with those at 2 weeks after operation, the increase rate of true lumen volume, the increase in the maximum diameter of the distal true lumen, and the area distal to the stent were increased in the two groups at 6 months after operation(P<0.05). There was no significant difference in the rate of false lumen thrombosis between the two groups at 6 months after operation(P>0.05). The total incidence of recent complications in Castor group [5.56%(2/36)] was lower than that in Longuette group [21.62%(8/37)](P<0.05). There was no significant difference in the incidence of mid-term complications between the Castor group [2.78%(1/36)] and the Longuette group [8.11%(3/37)](P>0.05). Conclusion Both Castor single-branch stent and Longuette chimney stent can achieve good efficacy and safety in the treatment of TBAD involving LSA in the acute stage. Both of them have the same effect in promoting aortic remodeling and false lumen thrombosis. However, although Castor single-branch stent technology has longer duration of operation and fluoroscopy time, it has advantages in reducing the risk of short-term complications such as endoleak and stent displacement, showing better early safety.
[1]周世方，丁宁，杨志伟，等.无痛性主动脉夹层八例临床特点和误诊分析[J].临床误诊误治，2023,36(1):5-8. DOI:10.3969/j.issn.1002-3429.2023.01.002.
[2]叶鹏.完全经皮途径原位微针穿刺开窗技术在累及主动脉弓部病变的临床系列研究[D].广州：南方医科大学，2023. DOI:10.27003/d.cnki.gojyu.2023.000046.
[3]SCHIZAS N,NAZOU G,SAMIOTIS I,et al. Is TEVAR an effective approach to prevent complications after surgery for aortic dissection type A a systematic review[J]. Healthcare,2024,12(13):1263.DOI:10.3390/healthcare12131263.
[4]NIKLAS N,KRóLIKOWSKA K,ZDRODOWSKA K,et al. The rate of postoperative complications in complicated acute,and subacute type B aortic dissections after TEVAR vs. PETTICOAT procedures:systematic review and meta-analysis[J]. Medicina,2023,59(12):2150. DOI:10.3390/medicina59122150.
[5]ELESHRA A,HEO W,LEE K H,et al. Mid-term outcomes of hybrid debranching endovascular aortic arch repair in landing zones 0–2[J].Vascular,2023,31(3):447-454. DOI:10.1177/17085381211068230.
[6]左逸，周正春，宣海洋，等.采用Castor分支型支架治疗累及左锁骨下动脉的Stanford B型主动脉夹层[J].中华胸心血管外科杂志，2021,37(11):683-685. DOI:10.3760/cma.j.cn112434-20210818-00275.
[7]KAWAHARA Y,OMINE K,KUTSUZAWA R,et al. Embolization Using a Debranched Left Common Carotid Artery Stump for Gutter Endoleak After Thoracic Endovascular Aortic Repair with the Double-debranching and Chimney Technique[J]. Kyobu Geka,2023,76(8):597-601. DOI:10.2995/kmj.2023-0044.
[8]方敏，张昊，张雷，等. Castor单分支支架腔内治疗Stanford B型主动脉夹层单中心回顾性研究[J].中国普通外科杂志，2024,33(6):901-908. DOI:10.7659/j.issn.1005-6947.2024.06.005.
[9]张红刚.不同手术方案对Stanford B型主动脉夹层腔内修复术后主动脉重塑的影响[D].南京：南京医科大学，2019.
[10]IWAKOSHI S,SAKAGUCHI S,MURATA M,et al. Efficacy of the stripped AFX aortic cuff as a scaffolding bare stent to facilitate the expansion of the thoracoabdominal and visceral aorta during thoracic endovascular aortic repair for complicated stanford type B aortic dissection[J]. Interv Radiol,2024,9(2):49-54. DOI:10.1007/s00270-023-03265-5.
[11]NAAZIE I,SANDHU H,DOSLUOGLU H,et al. Endovascular versus surgical left subclavian artery revascularization with thoracic endovascular aortic repair involving the aortic arch[J]. J Vasc Surg,2025,81(6):1280-1287. e1. DOI:10.1016/j.jvs.2024.12.029.
[12]CHENG Z,LIU Y,MA X. Comparative analysis of endovascular repair of single-branched stent-graft and hybrid procedure for patients with type B acute aortic dissection involving the left subclavian artery[J]. J Endovasc Ther,2024,31(5):892-900. DOI:10.1016/j.jevt.2024.03.011.
[13]DE BEAUFORT H W L,VOS J A,HEIJMEN R H. Initial single-center experience with the knickerbocker technique during thoracic endovascular aortic repair to block retrograde false lumen flow in patients with type B aortic dissection[J]. J Endovasc Ther,2024,31(4):597-605. DOI:10.1016/j.jevt.2024.02.009.
[14]WAMALA I,NAZARI-SHAFTI M T Z,HECK R,et al. Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection[J]. Interact CardioVascular Thorac Surg,2022,35(5):ivac244. DOI:10.1093/icvts/ivac244.
[15]MATSUOKA T,HASHIZUME K,HONDA M,et al. The provisional extension to induce complete attachment technique is associated with abdominal aortic remodeling and reduces aorta-related adverse events after aortic dissection[J]. J Vasc Surg,2021,74(1):45-52. e1. DOI:10.1016/j.jvs.2020.08.065.
[16]GUSEV M V,LEONG B V,PATEL S T. A reversed strategy for treating type B aortic dissection with open aortoiliac replacement prior to thoracic endovascular aortic repair[J]. J Vasc Surg Cases Innov Tech,2022,8(4):781-786. DOI:10.1016/j.jvscit.2022.06.015.
[17]王辰，庞昕焱.近端锚定区不足的主动脉弓部疾病腔内修复术中Castor分支支架置入联合体外预开窗应用观察[J].山东医药，2023,63(23):62-64. DOI:10.3969/j.issn.1002-266X.2023.23.015.
[18]李华，陈景伟，钟汝核，等. C a s t o r分支型支架在累及左锁骨下动脉Stanford B型主动脉夹层治疗中的应用[J].实用中西医结合临床，2023,23(16):68-71. DOI:10.13638/j.issn.1671-4040.2023.16.019.
[19]李振东，陈丹，杨光.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[J].河南医学研究，2024,33(12):2141-2144. DOI:10.3969/j.issn.1004-437X.2024.12.006.
[20]金蝶.近端锚定区不足B型夹层腔内修复术中的支架选择及疗效比较[D].济南：山东大学，2023. DOI:10.27272/d.cnki.gshdu.2023.006077.
[21]KUDO T,KURATANI T,SHIRAKAWA Y,et al. Comparison of the outcomes of total endovascular aortic arch repair between branched endograft and chimney endograft technique in zone 0 landing[J]. J Endovasc Ther,2022,29(3):427-437. DOI:10.1016/j.jevt.2022.01.009.
[22]CHASSIN-TRUBERT L,GANDET T,LOUNES Y,et al. Double fenestrated physician-modified stent-grafts for total aortic arch repair in 50 patients[J]. J Vasc Surg,2021,73(6):1898-1905. e1. DOI:10.1016/j.jvs.2020.11.065.
[23]SHU C,WAN Z,LUO M,et al. Mid-term results of a prospective study for aortic dissection with a gutter-plugging chimney stent graft[J]. Eur J Cardiothorac Surg,2024,65(5):ezae135. DOI:10.1093/ejcts/ezae135.
[24]周奕安.分支型支架治疗累及左锁骨下动脉的Stanford B型夹层临床报告[D].衡阳：南华大学，2021. DOI:10.27234/d.cnki.gnhuu.2021.000375.
[25]李晓恒，李燕平，付晓可，等.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[J].医学临床研究，2024,41(6):842-845. DOI:10.3969/j.issn.1671-7171.2024.06.012.
[26]王振华，宋晗，韦铎亮，等.急性B型主动脉夹层Castor单分支支架置入术后近端主动脉的早期重塑[J].山东大学学报(医学版)，2023,61(2):36-42. DOI:10.6040/j.issn.1671-7554.0.2022.0854.
[27]DUEPPERS P,REUTERSBERG B,RANCIC Z,et al. Long-term results of total endovascular repair of arch-involving aortic pathologies using parallel grafts for supra-aortic debranching[J]. J Vasc Surg,2022,75(3):813-823. e1. DOI:10.1016/j.jvs.2021.07.064.
[28]NAAZIE I,SANDHU H,DOSLUOGLU H,et al. Endovascular versus surgical left subclavian artery revascularization with thoracic endovascular aortic repair involving the aortic arch[J]. J Vasc Surg,2025,81(6):1280-1287. e1. DOI:10.1016/j.jvs.2024.12.029.
[29]朱凡，郭媛媛，李慧，等.单分支主动脉覆膜支架修复伴锚定区不足的急性Stanford B型夹层：附8例报告[J].中国普通外科杂志，2021,30(12):1403-1410. DOI:10.7659/j.issn.1005-6947.2021.12.003.
[30]曹军生，彭珊，车辙.一体化单分支型主动脉支架腔内修复Stanford B型主动脉夹层的疗效体会[J].中国普外基础与临床杂志，2022,29(12):1628-1631. DOI:10.7507/1007-9424.202205017.
[31]孙玉桂，张显岚，孙江滨.“单向”导丝技术结合新型Castor分支支架植入在Stanford B型主动脉夹层患者胸主动脉腔内修复术中的应用效果及体会[J].实用心脑肺血管病杂志，2020,28(6):68-73. DOI:10.3969/j.issn.1008-5971.2020.06.013.
[32]庄家祥. Castor支架在主动脉病变中的临床应用及疗效分析[D].福州：福建医科大学，2023.DOI:10.27020/d.cnki.gfjyu.2023.001102.
基本信息:
中图分类号:R654.3
引用信息:
[1]柳娟娟,张勇,任超,等.Castor单分支支架与Longuette烟囱支架技术治疗急性期累及LSA的Stanford B型主动脉夹层效果比较[J].临床误诊误治,2026,39(02):34-40.
基金信息:
山东省中医药科技项目(M-2023336); 济南市科技计划项目(202134002)
2026-01-27
2026-01-27