The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection
The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection
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DOI：
10.1016/j.jvs.2014.09.024
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发表时间：
2015-02-01
影响因子：
4.3
通讯作者：
Rasche, Volker
中科院分区：
文献类型：
--
作者：
Oberhuber, Alexander;Schabhasian, David;Rasche, Volker
背景：本研究使用磁共振成像（MRI）分析钝性主动脉损伤血管内修复后的长期功能结果。方法：这项前瞻性研究纳入了1999年至2008年间接受治疗的53例患者中的27例。患者接受功能性多维增强MRI，并进行血流分析或主动脉顺应性测量，或两者兼而有之。10名患者接受美敦力Valiant（美敦力世界医疗公司，佛罗里达州Sunrise）治疗，14名患者接受Gore TAG (W. L. Gore & Associates，亚利桑那州Flagstaff)， 2名患者接受C (conformable)-TAG （W. L. Gore & Associates）支架移植。对于一些病人，可以在一段时间内重复测量。中位随访时间为3.92±2.7年。MRI参数为：三维血流：回声时间/重复时间= 3.1/5.3 ms, Delta x（像素密度）= 2.5 × 2.5 × 3mm (3)；呼吸导航仪，alpha = 15度，v(enc)（编码速度）= 200 cm/s，沿前后、左右和脚-头方向，40个心相。Cine：回声时间/重复时间= 1.7/3.4 ms, Delta x（像素密度）= 1.2 x 1.2 x 6mm(3)，屏气，alpha = 60度，40心相。结果：血流分析显示支架近端血流加速，非最佳支架对准患者血流加速值更高。不同装置之间没有发现差异（Gore的中位加速度为75.99 +/- 37.98 cm/s， Medtronic的中位加速度为71.59 +/- 17.22 cm/s）。随访期间数值稳定。在顺应性分析中，支架覆盖的主动脉部分几乎没有扩张，而升、降主动脉扩张正常。这种行为并没有随着时间的推移而改变。在支架的近端，可以注意到轻微的压迫（-0.5 +/- 0.14 mm），除了那些使用Gore公司的C-TAG装置的患者。结论：功能分析显示钝性主动脉损伤血管内修复后主动脉弓内支架鸟喙构型无不良长期预后。
Background: This study used magnetic resonance imaging (MRI) to analyze functional long-term outcome after endovascular repair of blunt aortic injury.Methods: This prospective study enrolled 27 of 53 patients who were treated between 1999 and 2008. Patients underwent functional multidimensional contrast-enhanced MRI with flow analysis or compliance measurements of the aorta, or both. Ten patients were treated with the Medtronic Valiant (Medtronic World Medical, Sunrise, Fla), 14 patients received a Gore TAG (W. L. Gore & Associates, Flagstaff, Ariz), and two received a C (conformable)-TAG (W. L. Gore & Associates) stent graft. For several patients, repetitive measurements over time could be done. Median follow-up was 3.92 +/- 2.7 years. The MRI parameters were: three-dimensional flow: echo time/repetition time = 3.1/5.3 ms, Delta x(pixel density) = 2.5 x 2.5 x 3 mm(3); respiratory navigator, alpha = 15 degrees, v(enc)(encoding velocity) = 200 cm/s along anterior-posterior, right-left, and foot-head direction, 40 cardiac phases. Cine: echo time/repetition time = 1.7/3.4 ms, Delta x(pixel density) = 1.2 x 1.2 x 6 mm(3), breathhold, alpha = 60 degrees, 40 cardiac phases.Results: The flow analysis showed flow acceleration at the proximal end of the stent graft, with higher values in patients with a nonoptimal alignment of the stent graft. No differences were found between different devices (median acceleration was 75.99 +/- 37.98 cm/s for Gore and 71.59 +/- 17.22 cm/s for Medtronic). The values were stable during follow-up. In the compliance analysis, the part of the aorta covered with the stent graft showed nearly no expansion, whereas the ascending and descending aorta showed normal expansion. This behavior did not change over the time. At the proximal end of the stent graft, a slight compression could be noted (-0.5 +/- 0.14 mm), except in those patients with a C-TAG device from Gore.Conclusions: Functional analysis showed no adverse long-term outcome of the bird beak configuration of stent grafts in the aortic arch after endovascular repair after blunt aortic injury.