Laser fenestration of aortic arch stent grafts for endovascular treatment of retrograde type A dissection
Laser fenestration of aortic arch stent grafts for endovascular treatment of retrograde type A dissection
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DOI：
10.1016/j.ijcard.2020.12.011
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发表时间：
2021-02-27
影响因子：
3.5
通讯作者：
Lu, Xinwu
中科院分区：
文献类型：
--
作者：
Qin, Jinbao;Wu, Xiaoyu;Lu, Xinwu
目的：逆行性A型夹层是胸主动脉腔内修复术（TEVAR）后罕见但危及生命的事件，其全血管内治疗是一个巨大的挑战。本研究旨在评价在二尖瓣TEVAR期间主动脉弓覆膜支架原位激光开窗术的安全性、有效性、技术成功率和医疗结局。研究方法：我们回顾性分析了2016年3月至2019年12月期间在TEVAR期间接受主动脉弓覆膜支架原位激光开窗术的15例RIVER患者的临床数据。所有患者均接受术中体外脑灌注。收集并分析术前、术中和术后的医学资料。结果：15例患者平均年龄64.8岁，其中8例为男性。即刻总体技术成功率（包括主动脉支架展开）为100%，13例（86.7%）患者实现了一期开窗术成功。术后平均住院104天。1例发生脑卒中。未观察到院内/30天死亡或永久性截瘫/轻瘫。平均随访时间为13 +/- 5个月。发现2例Ia型内漏，但随访期间未观察到主动脉上分支动脉支架的晚期闭塞和移位。结论：对于不适合直接手术修复的患者而言，在RIVER的TEVAR期间，主动脉弓覆膜支架的原位激光开窗术是RIVER的潜在全血管内治疗。(c)2020由Elsevier B. V.出版
Objectives: Retrograde type A dissection (RTAD) is a rare but life-threatening event following thoracic endovascular aortic repair (TEVAR), and its total endovascular treatment is a huge challenge. This research aimed to evaluate the safety, effectiveness, technical success, and medical outcomes of in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD. Methods: We retrospectively reviewed the clinical data of 15 patients with RTAD who received in situ laser fenestration of aortic arch stent grafts during TEVAR between Mar 2016 and Dec 2019. All patients were subjected to intraoperative extracorporeal brain perfusion. The preoperative, intraoperative and postoperative medical data were collected and analyzed. Results: The mean age of the 15 patients was 64 8 years, 8 of whom were male. The immediate overall technical success rates, including aortic stent deployment were 100% and primary fenestration success was achieved in 13 (86.7%) patients. The mean postoperative length of stay was 10 4 days. Stroke occurred in 1 case. No inhospital/30-day death nor permanent paraplegia/paresis was observed. The mean follow-up time was 13 +/- 5 months. Two type Ia endoleaks were found, but no late occlusion and migration of the supra-aortic branch arteries stents during the follow-up were observed. Conclusions: The in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD is a potential total endovascular therapy of RTAD for patients unsuitable for direct surgical repair. (c) 2020 Published by Elsevier B.V.