Castor单分支支架与单烟囱支架在胸主动脉疾病中重建左侧锁骨下动脉的疗效分析及评价

Analysis and Evaluation of the Efficacy of Castor Single-Branch Stent and Single-Chimney Stent in the Reconstruction of the Left Subclavian Artery in Thoracic Aortic Disease

摘要: 目的：总结分析Castor单分支支架与单烟囱支架在治疗胸主动脉疾病中重建左锁骨下动脉的经验与体会。方法：回顾性分析2015年12月至2019年6月期间我院因胸主动脉疾病就诊的42例患者临床资料。42例患者中，应用Castor单分支支架19例，其中Stanford B型主动脉夹层13例，主动脉瘤5例，主动脉溃疡1例；应用单烟囱支架的23例，其中Stanford B型主动脉夹层14例，主动脉瘤7例，主动脉溃疡2例，比较两组在围手术期和随访期间的结果，尤其是在主动脉重塑以及内漏等并发症方面。结果：Castor单分支支架及单烟囱支架手术技术成功率均为100%且住院期间无死亡、脑卒中及截瘫患者。19例Castor支架组患者术后I型内漏1人，23例烟囱支架组患者，I型内漏7例，随访期间无死亡。Castor支架组随访时间为(18.9 ± 5.9)个月，分支支架通畅率为100%，烟囱支架随访时间为(15.5 ± 8.7)个月，烟囱支架通畅率为91.3%。结论：Castor单分支支架与单烟囱支架均可用于治疗累积左锁骨下动脉的胸主动脉疾病，近中期通畅率满意。Castor支架对左侧锁骨下动脉成角要求较低，术后假腔完全血栓化概率高，对于左锁骨下动脉成角大的患者优先考虑Castor支架，远期效果有待继续随访观察。

Abstract: Objective: To summarize and analyze the experience of Castor single branch stent and single chimney stent in the reconstruction of the left subclavian artery in the treatment of thoracic aortic disease. Methods: Clinical data of 42 patients admitted to our hospital for aortic disease from December 2015 to June 2019 were retrospectively analyzed. Among the 42 patients, 19 patients were treated with Castor single-branch stent, including 13 patients with Stanford B aortic dissection, 5 patients with aortic aneurysm and 1 patient with aortic ulcer. Among the 23 patients treated with single-chimney stent, 14 were treated with Stanford B aortic dissection, 7 with aortic aneurysm, and 2 with aortic ulcer. Results: The success rate of Castor stent and chimney stent was 100% and there were no death, stroke or paraplegia patients. There was 1 type I endoleak of Castor stent group, and 7 type I endoleak of chimney stent group, both groups had no deaths during the follow-up period. The follow-up time of the Castor stent group was (18.9 ± 5.9) months, the patency rate of the branch stent was 100%, and the follow-up time of the chimney stent was (15.5 ± 8.7) months, and the patency rate of the chimney stent was 91.3%. Conclusion: Both the Castor single-branch stent and single-stack stent can be used for the treatment of thoracic aortic disease with cumulative left subclavian artery, with satisfactory near- and medium-term patency rates. Castor stent has a low requirement for left subclavian artery angulation, and a high probability of complete false lumen thrombosis after surgery. Castor stent is preferred for patients with large left subclavian artery angulation, and the long-term effect remains to be observed in follow-up.