Endovascular stent-graft placement for the treatment of acute aortic dissection
Endovascular stent-graft placement for the treatment of acute aortic dissection
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DOI：
10.1056/nejm199905203402004
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发表时间：
1999-05-20
影响因子：
158.5
通讯作者：
Miller, DC
中科院分区：
文献类型：
--
作者：
Dake, MD;Kato, N;Miller, DC
背景急性主动脉夹层的标准治疗方法是手术或药物治疗，这取决于病变的形态学特征和任何相关并发症。无论采用何种治疗方式，相关的死亡率和发病率都相当高。方法我们研究了血管内支架植入术治疗起源于胸降主动脉的急性主动脉夹层。我们评估了4例急性A型主动脉夹层（累及升主动脉）和15例急性B型主动脉夹层（局限于降主动脉）经腔内支架置入术的可行性、安全性和有效性。19例患者中有14例（74%）的夹层累及主动脉分支，7例（37%）患者出现多支血管的症状性损害。支架移植物由自膨胀不锈钢制成，表面覆盖编织聚酯或聚四氟乙烯材料。结果19例患者血管内支架植入术均取得了技术上的成功。15例（79%）患者实现了胸主动脉假腔完全血栓形成，4例（21%）患者实现了部分血栓形成。缺血性分支血管的血运重建，随后相应症状的缓解，发生在阻塞分支的76%。19名患者中有3人在30天内死亡，早期死亡率为16%（95%置信区间为0 - 32%）。在随后平均13个月的随访期间，无死亡病例，无动脉瘤或主动脉破裂病例。结论这些初步结果表明，支架覆盖初级入口撕裂可能是一种有希望的治疗急性主动脉夹层患者的新方法。然而，这项技术需要进一步的评估，以充分评估其治疗潜力。[J] .中华医学杂志1999；34(4):559 - 559。(C)1999年，马萨诸塞州医学协会。
Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable.Methods We studied the placement of endovascular stent-grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent-graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The stent-grafts were made of self-expanding stainless-steel covered with woven polyester or polytetrafluoroethylene material.Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 19 patients. Complete thrombosis of the thoracic aortic false lumen was achieved in 15 patients (79 percent), and partial thrombosis was achieved in 4 (21 percent). Revascularization of ischemic branch vessels, with subsequent relief of corresponding symptoms, occurred in 76 percent of the obstructed branches. Three of the 19 patients died within 30 days, for an early mortality rate of 16 percent (95 percent confidence interval, 0 to 32 percent). There were no deaths and no instances of aneurysm or aortic rupture during the subsequent average follow-up period of 13 months.Conclusions These initial results suggest that stent-graft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully. (N Engl J Med 1999;340:1546-52.) (C)1999, Massachusetts Medical Society.