Management of complicated aortic aneurysms using multiple overlapping uncovered stents: mid-term outcome from a cohort study.
Management of complicated aortic aneurysms using multiple overlapping uncovered stents: mid-term outcome from a cohort study.
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使用多个重叠的未覆盖支架治疗复杂的主动脉瘤：队列研究的中期结果。
DOI：
10.1097/md.0000000000000209
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发表时间：
2014-12
期刊：
影响因子：
1.6
通讯作者：
Jing Z
中科院分区：
文献类型：
--
作者：
Zhang Y;Teng Z;Lu Q;Zhao Z;Bao J;Feng X;Feng R;Chen Z;Huang Y;Sadat U;Gillard JH;Jing Z
本研究旨在报告改良血流导向策略治疗不同形态复杂主动脉瘤的中期结局。历史数据表明，在使用当前市售血流导向装置进行血管内治疗后，主动脉瘤扩张和破裂，表明在大规模临床应用之前对该技术进行进一步研究的必要性。本研究采用了一种替代的血流导向策略，即采用逐层组装的多个重叠无覆膜支架。在中期随访期间评估了不同形态（囊状、梭形和夹层）动脉瘤的治疗结局。在入组本研究的42例患者（30例男性，平均年龄：63.3岁）中，40例患者实现了技术成功。在平均20.9个月的随访期内，平均动脉瘤直径从53.4 ± 13.6 mm缩小至48.8 ± 13.9 mm（P <0.001），而支架诱导的囊血栓形成率显著增加（18.1 ± 14.9%至93.6 ± 9.5%，P <0.001）。 大多数侧支（74/76条内脏大动脉，237/244条小段动脉）平均被3.3枚支架覆盖，支架置入后保持通畅。与梭形和夹层动脉瘤相比，囊状动脉瘤表现出最高的血栓沉积速度（18/20例在12个月内完全形成血栓）和最显著的收缩（术前51.4± 13.3 mm vs随访期间43.5± 10.2 mm，P <0.001）。 这种改良的血流导向策略可能是管理需要保留重要分支的复杂主动脉瘤的可行替代方案。治疗结果可能取决于动脉瘤的类型。需要更大患者队列和更长随访时间的进一步研究来证实这些结果。
Supplemental Digital Content is available in the text This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results.